Autumn Leaves Assisted Living Care Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

030361 Issued in TX

Legal business name

AUTUMN LEAVES ASSISTED LIVING CARE INC

Practice address

6411 Ridge Place St
San Antonio, TX 78250-4038

Phone

(210) 256-0553

Fax

(210) 680-1343

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Wilma Julia La Croix, R.N. ALPCM

Title

Owner

Phone

(210) 256-0553

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Autumn Leaves Assisted Living Inc Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1992841746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9202 NEW GUILBEAU RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782505802",
            "telephone_number": "210-844-7927",
            "fax_number": "210-463-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 RIDGE PLACE ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782504038",
            "telephone_number": "210-256-0553",
            "fax_number": "210-680-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN LEAVES ASSISTED LIVING CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "LA CROIX",
        "authorized_official_first_name": "WILMA",
        "authorized_official_middle_name": "JULIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-256-0553",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N. ALPCM"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "TX",
            "license": "030361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992841746",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wilma.lacroix@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6411 Ridge Place St",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782504038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Autumn Leaves Assisted Living Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.