Provider Demographics
NPI:1225452949
Name:FOUR SEASONS HEALTHCARE
Entity type:Organization
Organization Name:FOUR SEASONS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MBA
Authorized Official - Phone:610-572-2034
Mailing Address - Street 1:776 COBB HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7831
Mailing Address - Country:US
Mailing Address - Phone:610-572-2034
Mailing Address - Fax:610-552-9619
Practice Address - Street 1:776 COBB HILL LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7831
Practice Address - Country:US
Practice Address - Phone:610-572-2034
Practice Address - Fax:610-552-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEHHAAO-021A253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA000000405Medicaid