Provider Demographics
NPI:1326267063
Name:AUTUMN VILLA INC.
Entity Type:Organization
Organization Name:AUTUMN VILLA INC.
Other - Org Name:AUTUMN VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUROCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-333-5050
Mailing Address - Street 1:3579 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1614
Mailing Address - Country:US
Mailing Address - Phone:401-333-5050
Mailing Address - Fax:
Practice Address - Street 1:3579 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1614
Practice Address - Country:US
Practice Address - Phone:401-333-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01416310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility