Healthcare Provider Details

I. General information

NPI: 1639690019
Provider Name (Legal Business Name): AUTUMN ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 E BETHANY DR STE 102
AURORA CO
80014-2640
US

IV. Provider business mailing address

10640 E BETHANY DR STE 102
AURORA CO
80014-2640
US

V. Phone/Fax

Practice location:
  • Phone: 303-260-8019
  • Fax:
Mailing address:
  • Phone: 303-260-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAN WANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-260-8019