Provider Demographics
NPI:1750521118
Name:AUTUMN HOME CARE OF NAPERVILLE, INC
Entity type:Organization
Organization Name:AUTUMN HOME CARE OF NAPERVILLE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OMLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-957-0952
Mailing Address - Street 1:3655 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7351
Mailing Address - Country:US
Mailing Address - Phone:815-636-0860
Mailing Address - Fax:815-636-0866
Practice Address - Street 1:3655 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-7351
Practice Address - Country:US
Practice Address - Phone:815-636-0860
Practice Address - Fax:815-636-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011093251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health