Provider Demographics
NPI:1679189138
Name:FOUR SEASONS RANCH, LLC.
Entity Type:Organization
Organization Name:FOUR SEASONS RANCH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-632-4578
Mailing Address - Street 1:5625 ELM HILL DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1943
Mailing Address - Country:US
Mailing Address - Phone:216-632-4578
Mailing Address - Fax:
Practice Address - Street 1:5625 ELM HILL DR
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1943
Practice Address - Country:US
Practice Address - Phone:216-632-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home