Organization
SEAPORT VILLAGE SKILLED NURSING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BOWDEN (CEO)
(207) 874-2700
Entity
Organization
Contact information
Practice address
19 GENERAL MOORE WAY, ELLSWORTH, ME 04605-1806
(207) 667-9336
Mailing address
19 GENERAL MOORE WAY, ELLSWORTH, ME 04605-1806
(207) 667-9336
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
36346
ME
261QP2000X
Physical Therapy Clinic/Center
36346
ME
261QX0100X
Occupational Medicine Clinic/Center
36346
ME
314000000X
Skilled Nursing Facility
Primary
36555
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104690000
—
ME
Enumeration date
10/27/2005
Last updated
11/19/2014
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