Provider Demographics
NPI:1871635979
Name:AUTUMN HOME CARE FACILITIES INC
Entity Type:Organization
Organization Name:AUTUMN HOME CARE FACILITIES INC
Other - Org Name:AUTUMN PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-856-3678
Mailing Address - Street 1:144 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BAXTER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66713-1268
Mailing Address - Country:US
Mailing Address - Phone:620-856-3678
Mailing Address - Fax:620-856-3796
Practice Address - Street 1:311 S EAST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-2181
Practice Address - Country:US
Practice Address - Phone:620-429-1011
Practice Address - Fax:620-429-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN011007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility