MEDICARE: AUTUMN WINDS HOME HEALTH & HOSPICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396034104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN WINDS HOME HEALTH & HOSPICE

Provider Business Mailing Address
First Line	:	25755 N CHAMPAGNE LN
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-3420
Country	:	US
Telephone Number	:	928-925-3263
Fax Number	:

Provider Business Practice Location Address
First Line	:	25755 N CHAMPAGNE LN
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-3420
Country	:	US
Telephone Number	:	928-925-3263
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICK JONES
Credential	:
Telephone Number	:	928-925-3263

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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