Provider Demographics
NPI:1639839871
Name:FOUR SEASONS HOME CARE LLC
Entity Type:Organization
Organization Name:FOUR SEASONS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-494-5393
Mailing Address - Street 1:331 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2113
Mailing Address - Country:US
Mailing Address - Phone:870-494-5393
Mailing Address - Fax:870-630-8181
Practice Address - Street 1:411 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3302
Practice Address - Country:US
Practice Address - Phone:870-494-5393
Practice Address - Fax:870-630-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty