Provider Demographics
NPI:1598910127
Name:AUTUMN GLEN AT DARTMOUTH
Entity Type:Organization
Organization Name:AUTUMN GLEN AT DARTMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-404-7441
Mailing Address - Street 1:239 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1992
Mailing Address - Country:US
Mailing Address - Phone:508-992-8880
Mailing Address - Fax:508-992-8884
Practice Address - Street 1:239 CROSS RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-992-8880
Practice Address - Fax:508-992-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1907000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility