Autumn Hills of Bemidji, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

358062 Issued in MN

Legal business name

AUTUMN HILLS OF BEMIDJI, INC.

Doing business as

Autumn Hills Home Care

Practice address

2528 Park Ave NW
Bemidji, MN 56601-2432

Phone

(218) 333-3854

Fax

(218) 333-3855

NPI assigned

Oct 3, 2012

Last updated

Oct 3, 2012By 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

Mrs. Shelley Jean Cloose, RN

Title

President

Phone

(218) 333-3854

Specialties & licenses 1

Addresses

Other names 1

• Autumn Hills Home Care Doing business as

Tax ID family

Autumn Hills Home Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Autumn Hills of Bemidji, Inc.

  • Assisted Living Facility
  • Bemidji, MN
  • NPI 1619199916
  NPD tax ID

Locations

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

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1659623536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 PARK AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012432",
            "telephone_number": "218-333-3854",
            "fax_number": "218-333-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 PARK AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012432",
            "telephone_number": "218-333-3854",
            "fax_number": "218-333-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN HILLS OF BEMIDJI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-03",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "CLOOSE",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-333-3854",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "358062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Hills Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jonas Attilus, MD
• Aurora Waasakone Community of Learners
• Autumn Hills of Bemidji, Inc.
• Kimberly Jean Sletta Avenson, MSW, LICSW
• Ethan Axtman
• Tiffany Alicia Axtman
• Alexandra Patricia Bader, MD
• Sanggyu Bae, MD

• Home Health Agency in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.