Provider Demographics
NPI:1831075423
Name:SACRED SEASONS LIFE CARE
Entity type:Organization
Organization Name:SACRED SEASONS LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PEAESHA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-923-3973
Mailing Address - Street 1:470 DACULA ROAD PO BOX 1424
Mailing Address - Street 2:715 BAILEY WOODS ROAD DACULA, GA 30019
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3001
Mailing Address - Country:US
Mailing Address - Phone:678-923-3973
Mailing Address - Fax:
Practice Address - Street 1:715 BAILEY WOODS RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1233
Practice Address - Country:US
Practice Address - Phone:678-923-3973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility