Healthcare Provider Details

I. General information

NPI: 1396034104
Provider Name (Legal Business Name): AUTUMN WINDS HOME HEALTH & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25755 N CHAMPAGNE LN
PAULDEN AZ
86334-3420
US

IV. Provider business mailing address

25755 N CHAMPAGNE LN
PAULDEN AZ
86334-3420
US

V. Phone/Fax

Practice location:
  • Phone: 928-925-3263
  • Fax:
Mailing address:
  • Phone: 928-925-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK JONES
Title or Position: CEO
Credential:
Phone: 928-925-3263