Healthcare Provider Details

I. General information

NPI: 1902403793
Provider Name (Legal Business Name): SEASONS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6467 CARMEL CREEK AVE
LAS VEGAS NV
89139-7021
US

IV. Provider business mailing address

PO BOX 778413
HENDERSON NV
89077-8413
US

V. Phone/Fax

Practice location:
  • Phone: 248-974-1350
  • Fax: 702-947-5352
Mailing address:
  • Phone: 702-357-8811
  • Fax: 702-947-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL LEVY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 702-899-4509