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General NPI Number Information
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NPI Number | 1386625622
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Entity Type | Organization
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Legal Business Name | AUTUMN BRIDGE, LLC
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 3500 NW 39TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112
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Country | US
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Telephone | 405-440-2440
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Fax | 405-440-2441
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Provider Business Mailing Address
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Address Line | 655 BRAWLEY SCHOOL RD SUITE 200
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City | MOORESVILLE
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State | NC
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Zip | 28117-9601
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Authorized Official
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Title or Position | VP OF LEGAL AFFAIRS
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Name | JESSICA KLEBERG
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Credential |
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Telephone | 704-662-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 4181
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License Number State | OK
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