Provider Demographics
NPI:1023400389
Name:AUTUMN RIDGE, L.P.
Entity Type:Organization
Organization Name:AUTUMN RIDGE, L.P.
Other - Org Name:AUTUMN RIDGE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MPA
Authorized Official - Phone:559-842-7727
Mailing Address - Street 1:1400 E SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-2666
Mailing Address - Country:US
Mailing Address - Phone:559-842-7727
Mailing Address - Fax:559-834-4783
Practice Address - Street 1:14280 W STANISLAUS AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1594
Practice Address - Country:US
Practice Address - Phone:559-842-7727
Practice Address - Fax:559-834-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107206271311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)