Provider Demographics
NPI:1336318286
Name:AUTUMNCARE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:AUTUMNCARE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-526-4378
Mailing Address - Street 1:342 BARNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8235
Mailing Address - Country:US
Mailing Address - Phone:706-210-7288
Mailing Address - Fax:
Practice Address - Street 1:211 E 7TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1408
Practice Address - Country:US
Practice Address - Phone:706-526-4378
Practice Address - Fax:706-526-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA328650128AMedicaid
GA328650128BMedicaid