Provider Demographics
NPI:1831553114
Name:AUTUMN RIDGE, L.P.
Entity type:Organization
Organization Name:AUTUMN RIDGE, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:559-304-7095
Mailing Address - Street 1:2008 N THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-8828
Mailing Address - Country:US
Mailing Address - Phone:559-304-7095
Mailing Address - Fax:
Practice Address - Street 1:14280 W STANISLAUS AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1594
Practice Address - Country:US
Practice Address - Phone:559-304-7095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107206271310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107206271OtherCA DEP'T. OF SOCIAL SERVICES - COMMUNITY CARE LICENSING