NPIMap

Organization Active NPI

Autumn House

  • Assisted Living Facility (Mental Illness)
  • St Petersburg, FL
National Provider Identifier
1831508241
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
AL6677 Issued in FL
Legal business name
AUTUMN HOUSE
Practice address
880 17TH Ave S
St Petersburg, FL 33701-5716
Phone
(727) 564-4956
NPI assigned
Aug 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2014

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

Authorized official

Name
Daniel Parks
Title
Administrator
Phone
(727) 564-4956

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X AL6677 FL Primary

Addresses

Primary practice location

880 17TH Ave S
St Petersburg, FL 33701-5716

Mailing address

880 17TH Ave S
St Petersburg, FL 33701-5716
Phone (727) 564-4956

National Provider Directory

National Provider Directory
Tax ID family
Autumn House2 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.

NPI Registry JSON

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1831508241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 17TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337015716",
            "telephone_number": "727-564-4956",
            "fax_number": "727-823-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 17TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337015716",
            "telephone_number": "727-564-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-11",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-564-4956"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL6677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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.