Provider Demographics
NPI:1932485315
Name:SEASONS HEALTH CARE GROUP LLC
Entity Type:Organization
Organization Name:SEASONS HEALTH CARE GROUP LLC
Other - Org Name:SEASONS HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIANANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-489-9191
Mailing Address - Street 1:126 W 200 N
Mailing Address - Street 2:P.O. BOX 2528
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2702
Mailing Address - Country:US
Mailing Address - Phone:435-628-1601
Mailing Address - Fax:
Practice Address - Street 1:126 W 200 N
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2702
Practice Address - Country:US
Practice Address - Phone:435-628-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT453564529001Medicaid
UT465144Medicare Oscar/Certification