Provider Demographics
NPI:1700431178
Name:AUTUMN'S PROMISE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:AUTUMN'S PROMISE ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SILTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-465-1181
Mailing Address - Street 1:1700 SPARTAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKEN
Mailing Address - State:WI
Mailing Address - Zip Code:54229-9384
Mailing Address - Country:US
Mailing Address - Phone:920-465-1181
Mailing Address - Fax:920-593-8324
Practice Address - Street 1:1700 SPARTAN RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKEN
Practice Address - State:WI
Practice Address - Zip Code:54229-9384
Practice Address - Country:US
Practice Address - Phone:920-465-1181
Practice Address - Fax:920-593-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility