Provider Demographics
NPI:1477648442
Name:SCG DURANT FOUR SEASONS, LLC
Entity Type:Organization
Organization Name:SCG DURANT FOUR SEASONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2700
Mailing Address - Street 1:16 NORCROSS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3864
Mailing Address - Country:US
Mailing Address - Phone:770-255-1810
Mailing Address - Fax:770-255-0059
Practice Address - Street 1:16 NORCROSS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3810
Practice Address - Country:US
Practice Address - Phone:770-255-1810
Practice Address - Fax:770-255-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 0704314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100769540AMedicaid
1215926928OtherNPI
1215926928OtherNPI