Provider Demographics
NPI:1750902771
Name:AUTUMN CAROLINA LLC
Entity type:Organization
Organization Name:AUTUMN CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QP, CDS
Authorized Official - Phone:980-335-1222
Mailing Address - Street 1:121 GREENWICH RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2365
Mailing Address - Country:US
Mailing Address - Phone:980-335-1222
Mailing Address - Fax:980-237-9266
Practice Address - Street 1:1545 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1607
Practice Address - Country:US
Practice Address - Phone:980-208-4647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)