Autumn Village LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0713 Issued in MA

Legal business name

AUTUMN VILLAGE LLC

Practice address

25 Oriol Dr
Worcester, MA 01605-1911

Phone

(508) 852-3330

Fax

(508) 595-1008

NPI assigned

Jul 18, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Sean D'Urso

Title

Owner

Phone

(508) 852-3330

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003815564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 ORIOL DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051911",
            "telephone_number": "508-852-3330",
            "fax_number": "508-595-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 ORIOL DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051911",
            "telephone_number": "508-852-3330",
            "fax_number": "508-595-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN VILLAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "D'URSO",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-852-3330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0928402",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.