Provider Demographics
NPI:1255804472
Name:FOUR SEASONS OF ADRIAN, LLC
Entity type:Organization
Organization Name:FOUR SEASONS OF ADRIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-805-0319
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MO
Mailing Address - Zip Code:64720-0064
Mailing Address - Country:US
Mailing Address - Phone:816-805-0319
Mailing Address - Fax:816-297-8787
Practice Address - Street 1:303 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720-9217
Practice Address - Country:US
Practice Address - Phone:816-805-0319
Practice Address - Fax:816-297-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities