Healthcare Provider Details

I. General information

NPI: 1619958881
Provider Name (Legal Business Name): AUTUMN LEAVES NURSING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 COUNTRY CLUB RD
WINNFIELD LA
71483-7084
US

IV. Provider business mailing address

PO BOX 591
WINNFIELD LA
71483-0591
US

V. Phone/Fax

Practice location:
  • Phone: 318-628-4153
  • Fax: 318-628-6171
Mailing address:
  • Phone: 318-628-4153
  • Fax: 318-628-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number833
License Number StateLA

VIII. Authorized Official

Name: MR. TEDDY RAY PRICE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-628-4116