Healthcare Provider Details

I. General information

NPI: 1467083147
Provider Name (Legal Business Name): SEASONS COMMUNITY OUTREACH SERVICES NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 W 159TH ST STE E
MARKHAM IL
60428-4062
US

IV. Provider business mailing address

16148 KEDZIE AVE
MARKHAM IL
60428-4603
US

V. Phone/Fax

Practice location:
  • Phone: 708-331-8875
  • Fax:
Mailing address:
  • Phone: 708-331-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: FAYE DODSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-331-8875