Healthcare Provider Details

I. General information

NPI: 1134257181
Provider Name (Legal Business Name): FOUR SEASONS IN HOME SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N 2ND ST
CLINTON MO
64735-1453
US

IV. Provider business mailing address

908 N 2ND ST
CLINTON MO
64735-1453
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-2600
  • Fax: 660-826-0021
Mailing address:
  • Phone: 660-826-2600
  • Fax: 660-826-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOSEPH DESTEFANE
Title or Position: PRESIDENT
Credential:
Phone: 660-826-2600