MEDICARE: FOUR WINDS/FOUR SEASONS ASSISTED LIVING HOMES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1053686089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR WINDS/FOUR SEASONS ASSISTED LIVING HOMES,LLC

Provider Business Mailing Address
First Line	:	2710 DEER HAVEN DR
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 DEER HAVEN DR
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-3048
Country	:	US
Telephone Number	:	205-292-4998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY L KEMP
Credential	:
Telephone Number	:	205-292-4998

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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Directions to “FOUR WINDS/FOUR SEASONS ASSISTED LIVING HOMES,LLC ” Practice Location

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