Provider Demographics
NPI:1134727845
Name:FOUR SEASONS ABA
Entity type:Organization
Organization Name:FOUR SEASONS ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-603-4600
Mailing Address - Street 1:6 MERIDIAN HOME LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2402
Mailing Address - Country:US
Mailing Address - Phone:786-351-4493
Mailing Address - Fax:
Practice Address - Street 1:6 MERIDIAN HOME LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-2402
Practice Address - Country:US
Practice Address - Phone:786-351-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services