Basic Information
| Provider Information | |||||||||
| NPI: | 1811227432 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUTUMN HILL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729564957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794746885 | ||||||||
| FaxNumber: | 4794749523 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HAMMONS AVE | ||||||||
| Address2: | |||||||||
| City: | BERRYVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726164300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704236966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2010 | ||||||||
| LastUpdateDate: | 02/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | KILGORE | ||||||||
| AuthorizedOfficialFirstName: | JENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4794746885 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 758 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 180138311 | 05 | AR | MEDICAID |