Healthcare Provider Details

I. General information

NPI: 1538593629
Provider Name (Legal Business Name): FOUR SEASONS OF WASHINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 E WASHINGTON ST
SABINA OH
45169-1253
US

IV. Provider business mailing address

201 COURTHOUSE PKWY
WASHINGTON COURT HOUSE OH
45160
US

V. Phone/Fax

Practice location:
  • Phone: 937-584-2497
  • Fax: 937-584-2508
Mailing address:
  • Phone: 937-584-2497
  • Fax: 937-584-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ALAN ROSS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 937-584-2497