Basic Information
| Provider Information | |||||||||
| NPI: | 1437355385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUTUMN WIND OF BRYSON CITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 570 LANE RD | ||||||||
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| City: | DUNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283346270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108925225 | ||||||||
| FaxNumber: | 9108925225 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 HUGHES BRANCH RD. | ||||||||
| Address2: | |||||||||
| City: | BRYSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284882780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEWART | ||||||||
| AuthorizedOfficialFirstName: | MARTHA | ||||||||
| AuthorizedOfficialMiddleName: | STEPHENS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9108925225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL087002 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 307ECS40 | 05 | NC | MEDICAID |