Provider Demographics
NPI:1043632789
Name:ALL SEASONS HEALTHCARE, INC
Entity type:Organization
Organization Name:ALL SEASONS HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-602-0300
Mailing Address - Street 1:PO BOX 3635
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4018
Mailing Address - Country:US
Mailing Address - Phone:803-602-0300
Mailing Address - Fax:803-929-7761
Practice Address - Street 1:7142 WOODROW ST
Practice Address - Street 2:SUITE B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2832
Practice Address - Country:US
Practice Address - Phone:803-602-0300
Practice Address - Fax:803-929-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X, 251G00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421625Medicare UPIN