Provider Demographics
NPI:1285831354
Name:AUTUMN WIND OF SMITHFIELD, INC.
Entity Type:Organization
Organization Name:AUTUMN WIND OF SMITHFIELD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-7050
Mailing Address - Street 1:4302 NC HIGHWAY 210
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7915
Mailing Address - Country:US
Mailing Address - Phone:919-934-7050
Mailing Address - Fax:919-934-3584
Practice Address - Street 1:4302 NC HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7915
Practice Address - Country:US
Practice Address - Phone:919-934-7050
Practice Address - Fax:919-934-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-30
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-051-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility