Autumn Wood Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

375553 Issued in OK

Legal business name

AUTUMN WOOD OPCO, LLC

Practice address

2700 N Hickory St
Claremore, OK 74017-1214

Phone

(918) 283-4949

Fax

(918) 283-4508

NPI assigned

Sep 11, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Theresa Mere

Title

Associate

Phone

(325) 691-5591

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1184059982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 N HICKORY ST",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740171214",
            "telephone_number": "918-283-4949",
            "fax_number": "918-283-4508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 N HICKORY ST",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740171214",
            "telephone_number": "918-283-4949",
            "fax_number": "918-283-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN WOOD OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MERE",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "ASSOCIATE",
        "authorized_official_telephone_number": "325-691-5591"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "OK",
            "license": "NH6609",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "375553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200478150A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Claremore, OK
• Providers in Claremore, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.