Healthcare Provider Details

I. General information

NPI: 1992989032
Provider Name (Legal Business Name): AUTUMN ADULT FOSTER CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9214 HEINO RD
ANGORA MN
55703
US

IV. Provider business mailing address

9214 HEINO RD
ANGORA MN
55703
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-2401
  • Fax:
Mailing address:
  • Phone: 218-741-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: JANIS AROLA
Title or Position: OWNER
Credential:
Phone: 218-741-2401