Autumn Village, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL5221 Issued in FL

Legal business name

AUTUMN VILLAGE, INC.

Practice address

1103 Barrs Street
Jacksonville, FL 32204

Phone

(904) 384-7506

Fax

(904) 384-7279

NPI assigned

May 8, 2013

Last updated

May 8, 2013By 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

Ms. Alexandra Carpenter

Title

Director of Admissions

Phone

(904) 384-7506

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1851736540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 BARRS ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044220",
            "telephone_number": "904-384-7506",
            "fax_number": "904-384-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 BARRS STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-384-7506",
            "fax_number": "904-384-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "DIRECTOR OF ADMISSIONS",
        "authorized_official_telephone_number": "904-384-7506",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL5221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.