1831075423 NPI number — SACRED SEASONS LIFE CARE

Table of content: (NPI 1831075423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831075423 NPI number — SACRED SEASONS LIFE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED SEASONS LIFE CARE
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:
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:
1831075423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 DACULA ROAD PO BOX 1424
Provider Second Line Business Mailing Address:
715 BAILEY WOODS ROAD DACULA, GA 30019
Provider Business Mailing Address City Name:
DACULA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30019-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-923-3973
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 BAILEY WOODS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-923-3973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSTON
Authorized Official First Name:
PEAESHA
Authorized Official Middle Name:
LYNETTE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
678-923-3973

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com