Provider Demographics
NPI:1588991665
Name:FOUR SEASONS HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:FOUR SEASONS HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-733-0100
Mailing Address - Street 1:2165 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2179
Mailing Address - Country:US
Mailing Address - Phone:330-733-0100
Mailing Address - Fax:330-733-9638
Practice Address - Street 1:2165 EASTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305
Practice Address - Country:US
Practice Address - Phone:330-733-0100
Practice Address - Fax:330-733-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076633Medicaid
OH0076633Medicaid