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Organization
FOUR SEASONS REHAB, INC.
Active
Organization
FOUR SEASONS REHAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA BOURNE M.S., CCC-SLP (PRESIDENT)
(276) 322-5511
Entity
Organization
Contact information
Practice address
108 1/2 SPRUCE ST, BLUEFIELD, VA 24605-1738
(276) 322-5511
(276) 322-2525
Mailing address
PO BOX 536, BLUEFIELD, VA 24605-0536
(276) 322-5511
(276) 322-2525
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
2202001125
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154598000
—
WV
Enumeration date
09/13/2006
Last updated
08/22/2020
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