Provider Demographics
NPI:1457756652
Name:AM AUTUMN HOUSE LLC
Entity Type:Organization
Organization Name:AM AUTUMN HOUSE LLC
Other - Org Name:AUTUMN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-582-2400
Mailing Address - Street 1:145 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2220
Mailing Address - Country:US
Mailing Address - Phone:212-582-2400
Mailing Address - Fax:
Practice Address - Street 1:7999 SPYGLASS HILL RD
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7993
Practice Address - Country:US
Practice Address - Phone:212-582-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility