Provider Demographics
NPI:1164250361
Name:FOUR SEASONS SENIOR LIVING, LLC
Entity type:Organization
Organization Name:FOUR SEASONS SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:912-682-1827
Mailing Address - Street 1:3016 HAWKS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-4220
Mailing Address - Country:US
Mailing Address - Phone:912-682-1827
Mailing Address - Fax:
Practice Address - Street 1:30 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4509
Practice Address - Country:US
Practice Address - Phone:912-685-3033
Practice Address - Fax:912-685-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility