Provider Demographics
NPI:1023359353
Name:AUTUMN HALLS OF UNAKA, LLC
Entity type:Organization
Organization Name:AUTUMN HALLS OF UNAKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-835-8103
Mailing Address - Street 1:14949 JOE BROWN HWY
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-5570
Mailing Address - Country:US
Mailing Address - Phone:828-835-8103
Mailing Address - Fax:828-835-8103
Practice Address - Street 1:14949 JOE BROWN HWY
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-5570
Practice Address - Country:US
Practice Address - Phone:828-835-8103
Practice Address - Fax:828-835-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC030-034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804784Medicaid