MEDICARE: AUTUMN CAROLINA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1750902771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN CAROLINA LLC

Provider Business Mailing Address
First Line	:	121 GREENWICH RD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2365
Country	:	US
Telephone Number	:	980-335-1222
Fax Number	:	980-237-9266

Provider Business Practice Location Address
First Line	:	1545 PEACHTREE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-1607
Country	:	US
Telephone Number	:	980-208-4647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERRY D GREENE
Credential	:	BA, QP, CDS
Telephone Number	:	980-335-1222

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	12/02/2024

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Directions to “AUTUMN CAROLINA LLC ” Practice Location

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