Brock Halldale LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BROCK HALLDALE LLC

Doing business as

Halldale Assisted Living

Practice address

647 Maine Ave
Farmingdale, ME 04344-1526

Phone

(207) 622-7082

NPI assigned

Jan 3, 2025

Last updated

Jan 3, 2025By the provider in NPPES

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

• HALLDALE ASSISTED LIVING Doing business as

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": "1255140307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 MAINE AVE",
            "city": "FARMINGDALE",
            "state": "ME",
            "postal_code": "043441526",
            "telephone_number": "207-622-7082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 MAINE AVE",
            "city": "FARMINGDALE",
            "state": "ME",
            "postal_code": "043441526",
            "telephone_number": "207-622-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCK HALLDALE 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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HALLDALE ASSISTED LIVING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Farmingdale, ME
• Providers in Farmingdale, ME by specialty
• 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.