Healthcare Provider Details

I. General information

NPI: 1336318286
Provider Name (Legal Business Name): AUTUMNCARE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 7TH ST
WAYNESBORO GA
30830-1408
US

IV. Provider business mailing address

342 BARNSLEY DR
EVANS GA
30809-8235
US

V. Phone/Fax

Practice location:
  • Phone: 706-526-4378
  • Fax: 706-526-4378
Mailing address:
  • Phone: 706-210-7288
  • 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: MRS. PAT P MADRAY
Title or Position: OWNER
Credential:
Phone: 706-526-4378