Provider Demographics
NPI:1699530733
Name:FOUR SEASONS HOME CARE LLC
Entity type:Organization
Organization Name:FOUR SEASONS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:SHANQULA
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:463-253-0504
Mailing Address - Street 1:5401 S EAST ST STE 207D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2093
Mailing Address - Country:US
Mailing Address - Phone:463-201-6334
Mailing Address - Fax:463-203-0219
Practice Address - Street 1:5401 S EAST ST STE 207D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2093
Practice Address - Country:US
Practice Address - Phone:463-253-0504
Practice Address - Fax:463-203-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care