Provider Demographics
NPI:1710381710
Name:SEASONS HEALTH CARE, LLC.
Entity Type:Organization
Organization Name:SEASONS HEALTH CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSN, RN, ANP BC, GNP BC, CNOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-714-6931
Mailing Address - Street 1:3011 AUGUSTA TRCE SE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON COVE
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9319
Mailing Address - Country:US
Mailing Address - Phone:334-714-6931
Mailing Address - Fax:
Practice Address - Street 1:3011 AUGUSTA TRCE SE
Practice Address - Street 2:
Practice Address - City:HAMPTON COVE
Practice Address - State:AL
Practice Address - Zip Code:35763-9319
Practice Address - Country:US
Practice Address - Phone:334-714-6931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1 039213310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility