Provider Demographics
NPI:1922878990
Name:AUTUMN WELLS, LLC
Entity Type:Organization
Organization Name:AUTUMN WELLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:307-253-9308
Mailing Address - Street 1:7028 ORION DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-7247
Mailing Address - Country:US
Mailing Address - Phone:307-253-9308
Mailing Address - Fax:307-215-5521
Practice Address - Street 1:7028 ORION DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054
Practice Address - Country:US
Practice Address - Phone:307-253-9308
Practice Address - Fax:307-215-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management