NPIMap

Organization Active NPI

Autumn Park Inc

  • Assisted Living Facility
  • Washington, UT
National Provider Identifier
1487167805
Registry record updated Nov 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
000820 Issued in UT
Legal business name
AUTUMN PARK INC
Practice address
548 N 1100 E
Washington, UT 84780-2980
Phone
(435) 275-4458
NPI assigned
Nov 7, 2017
Last updated
Nov 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2017

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

Authorized official

Name
Patrick R JackmanNPI 1437668365
Title
Owner
Phone
(435) 275-4458

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 000820 UT Primary

Addresses

Primary practice location

548 N 1100 E
Washington, UT 84780-2980

Mailing address

PO Box 911415
St George, UT 84791-1415
Phone (435) 275-4458

National Provider Directory

National Provider Directory

Locations

548 N 1100 E
Washington, UT 84780
Phone (435) 275-4458

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1487167805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911415",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847911415",
            "telephone_number": "435-275-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 N 1100 E",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847802980",
            "telephone_number": "435-275-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN PARK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "JACKMAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-275-4458"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "UT",
            "license": "000820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.