Brock Tissues LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BROCK TISSUES LLC

Practice address

212 Fox Hill Rd
Athens, ME 04912-4719

Phone

(207) 654-2713

NPI assigned

Jan 3, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Wesbrock

Title

Chief Executive Officer

Phone

(207) 691-5059

Specialties & licenses 1

Addresses

Other names 1

• TISSUES ASSISTED LIVING Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1043029192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 FOX HILL RD",
            "city": "ATHENS",
            "state": "ME",
            "postal_code": "049124719",
            "telephone_number": "207-654-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 FOX HILL RD",
            "city": "ATHENS",
            "state": "ME",
            "postal_code": "049124719",
            "telephone_number": "207-654-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCK TISSUES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "WESBROCK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-691-5059"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TISSUES ASSISTED LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Davis Long Term Care Group Inc
• Davis Long Term Care Group Inc
• Jamie Louise Huff Hyde, LMT, DOULA

• All providers in Athens, ME
• Assisted Living Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.