Organization
FOUR SEASONS IN HOME SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD JOSEPH DESTEPHANE (PRESIDENT)
(660) 826-2600
Entity
Organization
Contact information
Practice address
908 N 2ND ST, CLINTON, MO 64735-1453
(660) 826-2600
(660) 826-0021
Mailing address
908 N 2ND ST, CLINTON, MO 64735-1453
(660) 826-2600
(660) 826-0021
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8000781
—
MO
Enumeration date
03/01/2007
Last updated
05/20/2024
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