Provider Demographics
NPI:1497249320
Name:AUTUMN WOODS III, LLC
Entity Type:Organization
Organization Name:AUTUMN WOODS III, LLC
Other - Org Name:RIVER OAKS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:952-920-0400
Mailing Address - Street 1:4601 EXCELSIOR BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4977
Mailing Address - Country:US
Mailing Address - Phone:952-697-4642
Mailing Address - Fax:
Practice Address - Street 1:910 WESTERN ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2002
Practice Address - Country:US
Practice Address - Phone:763-421-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUTUMN WOODS III, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility