Provider Demographics
NPI:1477988558
Name:AUTUMN WIND
Entity Type:Organization
Organization Name:AUTUMN WIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-434-9300
Mailing Address - Street 1:135 AUTUMN WIND CT
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-0017
Mailing Address - Country:US
Mailing Address - Phone:903-569-1111
Mailing Address - Fax:903-569-6007
Practice Address - Street 1:135 AUTUMN WIND CT
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-0017
Practice Address - Country:US
Practice Address - Phone:903-569-1111
Practice Address - Fax:903-569-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105574310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility