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General NPI Number Information
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NPI Number | 1467687533
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Entity Type | Organization
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Legal Business Name | SEASIDE HEALTHCARE LLC
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 850 BAXTER BLVD
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City | PORTLAND
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State | ME
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Zip | 04103-4901
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Country | US
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Telephone | 207-774-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 850 BAXTER BLVD
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City | PORTLAND
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State | ME
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Zip | 04103-4901
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Country | US
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Telephone | 207-774-7878
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | WANDA PELKEY
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Credential |
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Telephone | 207-874-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2009
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License Number State | ME
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