Healthcare Provider Details

I. General information

NPI: 1063878734
Provider Name (Legal Business Name): CESC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 BUCKSPORT RD SUITE A
ELLSWORTH ME
04605-2239
US

IV. Provider business mailing address

128 BUCKSPORT RD STE A
ELLSWORTH ME
04605-2239
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168