Provider Demographics
NPI:1518249069
Name:AUTUMNWOODS CERTIFIED RESIDENTIAL CARE FACILITY INC.
Entity Type:Organization
Organization Name:AUTUMNWOODS CERTIFIED RESIDENTIAL CARE FACILITY INC.
Other - Org Name:HALLMARK ACHIEVEMENTS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-556-3067
Mailing Address - Street 1:42015 FORD RD
Mailing Address - Street 2:405
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3669
Mailing Address - Country:US
Mailing Address - Phone:248-353-0928
Mailing Address - Fax:
Practice Address - Street 1:5232 OVERBROOK RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-5764
Practice Address - Country:US
Practice Address - Phone:205-556-3067
Practice Address - Fax:205-556-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health