Provider Demographics
NPI:1447441159
Name:SEASONS HOSPICE AND PALLIATIVE CARE OF MARYLAND, LLC
Entity type:Organization
Organization Name:SEASONS HOSPICE AND PALLIATIVE CARE OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-692-1148
Mailing Address - Street 1:606 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7008 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2566
Practice Address - Country:US
Practice Address - Phone:410-594-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403394900Medicaid