Provider Demographics
NPI:1417394917
Name:THE FOUR SEASONS ALF COMMUNITY INC
Entity Type:Organization
Organization Name:THE FOUR SEASONS ALF COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-626-9078
Mailing Address - Street 1:1127 MELVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6320
Mailing Address - Country:US
Mailing Address - Phone:941-391-6858
Mailing Address - Fax:
Practice Address - Street 1:1127 MELVILLE RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-6320
Practice Address - Country:US
Practice Address - Phone:941-391-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12133310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility