Healthcare Provider Details

I. General information

NPI: 1356402515
Provider Name (Legal Business Name): AUTUMN LEAVES NURSING AND REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 KILGORE DR
HENDERSON TX
75652-5215
US

IV. Provider business mailing address

321 KILGORE DR
HENDERSON TX
75652-5215
US

V. Phone/Fax

Practice location:
  • Phone: 903-657-1923
  • Fax: 903-657-6464
Mailing address:
  • Phone: 903-657-1923
  • Fax: 903-657-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116372
License Number StateTX

VIII. Authorized Official

Name: VIRGINIA BETH IRWIN
Title or Position: PRESIDENT
Credential:
Phone: 903-657-8969