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Autumn House

Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Greensboro, NC

NPI 1962646836 · NPPES record last updated Apr 23, 2009

Key facts

NPI
1962646836
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
License
MHL-041-874 (NC)
Legal business name
AUTUMN HOUSE
Practice address
3902 Derbyshire Dr
Greensboro, NC 27410-2216
Phone
(336) 288-7360
Fax
(336) 273-6522
NPI assigned
Apr 23, 2009
Organization subpart
Yes
Parent organization (as reported)
ALBERTA PROFESSIONAL SERVICES, INC.

Authorized official

Name
Mr. Derek Mitchell, BS, QP
Title
Operations Manager
Phone
(336) 273-2640

Corporate family (same tax ID) 14

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

National Provider Directory

Tax ID family
Taylor Home (15 organizations share this tax ID)
Part of
Taylor Home

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-041-874 NC Yes

Addresses

Primary practice location

3902 Derbyshire Dr
Greensboro, NC 27410-2216

Mailing address

1000 Revolution Mill Dr
Studio #2
Greensboro, NC 27405-5082
Phone (336) 273-2640

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 23, 2009.

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240444800000",
    "number": "1962646836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REVOLUTION MILL DR",
            "address_2": "STUDIO #2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055082",
            "telephone_number": "336-273-2640",
            "fax_number": "336-273-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 DERBYSHIRE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102216",
            "telephone_number": "336-288-7360",
            "fax_number": "336-273-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALBERTA PROFESSIONAL SERVICES,  INC.",
        "enumeration_date": "2009-04-23",
        "last_updated": "2009-04-23",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "336-273-2640",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS, QP"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-041-874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

All providers in Greensboro, NC · Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

Sources for this page

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