MEDICARE: AUTUMN RIDGE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1013859594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN RIDGE HOME CARE LLC

Provider Business Mailing Address
First Line	:	5351 3 MILE RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9061
Country	:	US
Telephone Number	:	989-284-8142
Fax Number	:

Provider Business Practice Location Address
First Line	:	5351 3 MILE RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9061
Country	:	US
Telephone Number	:	989-284-8142
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAULA LYNN MARTINEZ
Credential	:	NON-SKILLED CARE GIV
Telephone Number	:	989-284-8142

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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