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General NPI Number Information
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NPI Number | 1720277718
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Entity Type | Organization
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Legal Business Name | AUTUMN WOODS INC.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 5500 NW HOUSTON LAKE DR
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City | KANSAS CITY
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State | MO
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Zip | 64151-3472
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Country | US
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Telephone | 816-587-2263
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12008
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City | KANSAS CITY
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State | MO
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Zip | 64152-0008
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Country | US
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Telephone | 816-587-2263
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | VALERIE SCHULTZ
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Credential |
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Telephone | 816-587-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 034854
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License Number State | MO
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