Provider Demographics
NPI:1114924255
Name:SEASONS HOSPICE
Entity Type:Organization
Organization Name:SEASONS HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:507-285-1930
Mailing Address - Street 1:1696 GREENVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1363
Mailing Address - Country:US
Mailing Address - Phone:507-285-1930
Mailing Address - Fax:507-282-2737
Practice Address - Street 1:1696 GREENVIEW DR SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1363
Practice Address - Country:US
Practice Address - Phone:507-285-1930
Practice Address - Fax:507-282-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID 03427251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3Z25SEOtherBC/BS PROVIDER NUMBER
MN883344300Medicaid
MN241545Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER