Provider Demographics
NPI:1255662763
Name:AUTUMN WINDS LLC
Entity Type:Organization
Organization Name:AUTUMN WINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LETHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIENAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-1559
Mailing Address - Street 1:2905 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 E 6TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4000
Practice Address - Country:US
Practice Address - Phone:605-665-1559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility