Provider Demographics
NPI:1316121858
Name:SEASONS ADULT FOSTER CARE
Entity type:Organization
Organization Name:SEASONS ADULT FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LOYAL
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-838-6757
Mailing Address - Street 1:40195 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:BROWERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56438-5016
Mailing Address - Country:US
Mailing Address - Phone:218-894-1188
Mailing Address - Fax:
Practice Address - Street 1:310 WISCONSON AVE SE
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479
Practice Address - Country:US
Practice Address - Phone:218-894-1188
Practice Address - Fax:218-894-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049478-1-AFC310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness