Healthcare Provider Details

I. General information

NPI: 1225342702
Provider Name (Legal Business Name): SEASONS OF HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HAWTHORNE RD SUITE 3B
CHUBBUCK ID
83202-2376
US

IV. Provider business mailing address

4650 HAWTHORNE RD SUITE 3B
CHUBBUCK ID
83202-2376
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-9833
  • Fax: 208-237-1800
Mailing address:
  • Phone: 208-237-9833
  • Fax: 208-237-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberPSY202423
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License NumberPSY202423
License Number StateID

VIII. Authorized Official

Name: HEATH JACOB SOMMER
Title or Position: CLINCAL PSYCHOLOGIST/CEO
Credential: PH.D.
Phone: 208-237-9833