1609097443 NPI number — SEASONS OF CARE HEALTH SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609097443 NPI number — SEASONS OF CARE HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASONS OF CARE HEALTH SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609097443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 RAVINES EDGE COURT
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-444-4177
Provider Business Mailing Address Fax Number:
833-263-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4255 CENTER RD.
Provider Second Line Business Practice Location Address:
2ND FLOOR WELLNESS CENTER
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-444-4177
Provider Business Practice Location Address Fax Number:
833-263-0944
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAGAN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF CARE AND HOUSING
Authorized Official Telephone Number:
614-395-6233

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  368025 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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