Healthcare Provider Details

I. General information

NPI: 1417939612
Provider Name (Legal Business Name): SEAL ROCK ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 HARBOR DRIVE
SACO ME
04072
US

IV. Provider business mailing address

88 HARBOR DRIVE
SACO ME
04072
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-3646
  • Fax:
Mailing address:
  • Phone: 207-283-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36535
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number36535
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number36535
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number36312
License Number StateME

VIII. Authorized Official

Name: KENNETH BOWDEN
Title or Position: CEO
Credential:
Phone: 207-874-2700