Four Seasons Rehab, Inc.
Organization Active NPI Hearing and Speech Clinic/Center · Bluefield, VA
NPI 1164527628 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1164527628
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hearing and Speech Clinic/Center 261QH0700X
- License
- 2202001125 (VA)
- Legal business name
- FOUR SEASONS REHAB, INC.
- Practice address
- 108 1/2 Spruce St
Bluefield, VA 24605-1738 - Phone
- (276) 322-5511
- Fax
- (276) 322-2525
- NPI assigned
- Sep 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Victoria Bourne, M.S., CCC-SLP
- Title
- President
- Phone
- (276) 322-5511
Practitioners 1
-
Maria Mamone Holdren, M.S., CCC-A
National Provider Directory
Locations
108 Spruce St
Bluefield, VA 24605
Phone (276) 322-5511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hearing and Speech Clinic/Center | 261QH0700X | 2202001125 | VA | Yes |
Addresses
Primary practice location
108 1/2 Spruce St
Bluefield, VA 24605-1738
Mailing address
PO Box 536
Bluefield, VA 24605-0536
Phone (276) 322-5511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0154598000 | Medicaid | WV |
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All providers in Bluefield, VA · Hearing and Speech Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.