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General NPI Number Information
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NPI Number | 1821079161
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Entity Type | Organization
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Legal Business Name | AUTUMNBRIDGE SOUTHWEST LLC
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 2642 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1716
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Country | US
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Telephone | 918-236-4866
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Fax | 918-236-4867
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Provider Business Mailing Address
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Address Line | 2642 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1716
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Country | US
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Telephone | 918-236-4866
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Fax | 918-236-4867
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Authorized Official
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Title or Position | CONTROLLER
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Name | MR. WILLIAM LOWERY SLAUGHTER
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Credential |
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Telephone | 405-613-0055
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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 | 4196
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License Number State | OK
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