=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588991665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUR SEASONS HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 04/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2165 EASTWOOD AVENUE
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-733-0100
-----------------------------------------------------
Fax | 330-733-9638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2165 EASTWOOD AVE
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44305-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-733-0100
-----------------------------------------------------
Fax | 330-733-9638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | NICOLE A. STANICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-733-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------