Provider Demographics
NPI:1982834818
Name:AUTUMN HOUSE, INC.
Entity Type:Organization
Organization Name:AUTUMN HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-892-3456
Mailing Address - Street 1:1303 E MARSHALL HOWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-5901
Mailing Address - Country:US
Mailing Address - Phone:806-385-0364
Mailing Address - Fax:806-385-0365
Practice Address - Street 1:1303 E MARSHALL HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-5901
Practice Address - Country:US
Practice Address - Phone:806-385-0364
Practice Address - Fax:806-385-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100381310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100381Medicare Oscar/Certification