Healthcare Provider Details

I. General information

NPI: 1891850061
Provider Name (Legal Business Name): AUTUMNCARE ADULT DAY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 J DEWEY GRAY CIR
AUGUSTA GA
30909-6424
US

IV. Provider business mailing address

3654 J DEWEY GRAY CIR
AUGUSTA GA
30909-6424
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9888
  • Fax: 706-863-7277
Mailing address:
  • Phone: 706-863-9888
  • Fax: 706-863-7277

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: MRS. PAT P. MADRAY
Title or Position: PRESIDENT
Credential:
Phone: 706-863-9888