MEDICARE: BROCK LODGES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1275359556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCK LODGES LLC

Provider Business Mailing Address
First Line	:	51 MAIN ST
Second Line	:
City	:	SPRINGVALE
State	:	ME
Zip	:	04083-1843
Country	:	US
Telephone Number	:	207-324-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 MAIN ST
Second Line	:
City	:	SPRINGVALE
State	:	ME
Zip	:	04083-1843
Country	:	US
Telephone Number	:	207-324-4757
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KELLY WESBROCK
Credential	:
Telephone Number	:	207-691-5059

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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Directions to “BROCK LODGES LLC ” Practice Location

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