NPIMap

Organization Active NPI

Autumn Lake LLC

  • In Home Supportive Care Agency
  • Baton Rouge, LA
National Provider Identifier
1699153205
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
AUTUMN LAKE LLC
Practice address
11758 S Harrells Ferry Rd Ste C
Baton Rouge, LA 70816-2365
Phone
(225) 246-2740
Fax
(225) 367-4687
NPI assigned
May 14, 2015
Last updated
Aug 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Authorized official

Name
Cristal Riley
Title
Coo
Phone
(225) 246-2740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

11758 S Harrells Ferry Rd Ste C
Baton Rouge, LA 70816-2365

Mailing address

11758 S Harrells Ferry Rd Ste C
Baton Rouge, LA 70816-2365
Phone (225) 246-2740

Other practice location 1

5215 Essen Ln Ste 5
Baton Rouge, LA 70809-3563
Phone (225) 751-2409

Other identifiers 1

IdentifierTypeStateIssuer
1720500MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Autumn Lake LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1699153205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11758 S HARRELLS FERRY RD STE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708162365",
            "telephone_number": "225-246-2740",
            "fax_number": "225-367-4687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11758 S HARRELLS FERRY RD STE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708162365",
            "telephone_number": "225-246-2740",
            "fax_number": "225-367-4687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5215 Essen Ln Ste 5",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708093563",
            "country_code": "US",
            "telephone_number": "225-751-2409",
            "fax_number": "225-751-2466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUTUMN LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "CRISTAL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "225-246-2740"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720500",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.