Provider Demographics
NPI:1528199395
Name:AUTUMN SPRINGS ASSISTED LIVING
Entity Type:Organization
Organization Name:AUTUMN SPRINGS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-656-0422
Mailing Address - Street 1:3758 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7640
Mailing Address - Country:US
Mailing Address - Phone:406-656-0422
Mailing Address - Fax:406-656-1665
Practice Address - Street 1:3758 AVENUE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7640
Practice Address - Country:US
Practice Address - Phone:406-656-0422
Practice Address - Fax:406-656-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10822310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0621860Medicaid