Provider Demographics
NPI:1275738072
Name:FOUR SEASON
Entity Type:Organization
Organization Name:FOUR SEASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-994-3619
Mailing Address - Street 1:175 JACKSON AVE N STE 416
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8597
Mailing Address - Country:US
Mailing Address - Phone:952-994-3619
Mailing Address - Fax:
Practice Address - Street 1:175 JACKSON AVE N STE 416
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8597
Practice Address - Country:US
Practice Address - Phone:952-994-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN336116251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health