Provider Demographics
NPI:1225367550
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:MS
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:
Practice Address - Street 1:2165 EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2179
Practice Address - Country:US
Practice Address - Phone:330-733-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076633Medicaid
OH3111199Medicaid
OH368408Medicare UPIN