Healthcare Provider Details

I. General information

NPI: 1639839871
Provider Name (Legal Business Name): FOUR SEASONS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CLEVELAND ST
FORREST CITY AR
72335-3302
US

IV. Provider business mailing address

331 MISSISSIPPI ST
FORREST CITY AR
72335-2113
US

V. Phone/Fax

Practice location:
  • Phone: 870-494-5393
  • Fax: 870-630-8181
Mailing address:
  • Phone: 870-494-5393
  • Fax: 870-630-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE MURRAY
Title or Position: PRESIDENT/ADMIN
Credential:
Phone: 870-494-5393