Healthcare Provider Details

I. General information

NPI: 1053686089
Provider Name (Legal Business Name): FOUR WINDS/FOUR SEASONS ASSISTED LIVING HOMES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 DEER HAVEN DR
NORTHPORT AL
35473-3048
US

IV. Provider business mailing address

2710 DEER HAVEN DR
NORTHPORT AL
35473-3048
US

V. Phone/Fax

Practice location:
  • Phone: 205-292-4998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY L KEMP
Title or Position: OWNER
Credential:
Phone: 205-292-4998