Provider Demographics
NPI:1093477697
Name:SEASONS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:SEASONS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-274-3177
Mailing Address - Street 1:12542 SAVAGE CT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3636
Mailing Address - Country:US
Mailing Address - Phone:936-274-3177
Mailing Address - Fax:936-249-6486
Practice Address - Street 1:1 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1964
Practice Address - Country:US
Practice Address - Phone:936-274-3177
Practice Address - Fax:936-249-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110211OtherHHSC FACILITY ID #
TX146856OtherHHSC LICENSE #
TX307467OtherHHSC LICENSE #
TX104330OtherHHSC FACILITY ID#