Provider Demographics
NPI:1255523429
Name:THE AUTUMN GROUP, INC.
Entity type:Organization
Organization Name:THE AUTUMN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-572-1702
Mailing Address - Street 1:9767 NC 210 N
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-6632
Mailing Address - Country:US
Mailing Address - Phone:919-639-9000
Mailing Address - Fax:919-639-9435
Practice Address - Street 1:9767 NC 210 N
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6632
Practice Address - Country:US
Practice Address - Phone:919-639-9000
Practice Address - Fax:919-639-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC043-015310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803347Medicaid