Healthcare Provider Details

I. General information

NPI: 1093477697
Provider Name (Legal Business Name): SEASONS ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRIARWOOD DR
CONROE TX
77301-1964
US

IV. Provider business mailing address

12542 SAVAGE CT
MAGNOLIA TX
77354-3636
US

V. Phone/Fax

Practice location:
  • Phone: 936-274-3177
  • Fax: 936-249-6486
Mailing address:
  • Phone: 936-274-3177
  • Fax: 936-249-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAWN MEDLIN
Title or Position: CEO
Credential:
Phone: 936-274-3177