MEDICARE: FOUR SEASONS HEALTH SERVICES, 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	251E00000X	Home Health Agency
2	251E00000X	Home Health Agency		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588991665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SEASONS HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2165 EASTWOOD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2179
Country	:	US
Telephone Number	:	330-733-0100
Fax Number	:	330-733-9638

Provider Business Practice Location Address
First Line	:	2165 EASTWOOD AVENUE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305
Country	:	US
Telephone Number	:	330-733-0100
Fax Number	:	330-733-9638

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICOLE A. STANICH
Credential	:
Telephone Number	:	330-733-0100

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	04/12/2016

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