Provider Demographics
NPI:1619241833
Name:AUTUMN WIND, INC.
Entity Type:Organization
Organization Name:AUTUMN WIND, INC.
Other - Org Name:AUTUMN WIND ASSISTED LIVING OF LOUISBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GANIYU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-7050
Mailing Address - Street 1:214 SHILLINGS CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6483
Mailing Address - Country:US
Mailing Address - Phone:919-934-7050
Mailing Address - Fax:919-934-3584
Practice Address - Street 1:361 LEONARD RD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-8412
Practice Address - Country:US
Practice Address - Phone:919-853-3121
Practice Address - Fax:919-853-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility