Autumn Village, Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL-031-014 Issued in NC

Legal business name

AUTUMN VILLAGE, INC.

Practice address

235 N NC 41 Hwy
Beulaville, NC 28518-8633

Phone

(910) 298-5877

Fax

(910) 298-5578

NPI assigned

Apr 13, 2007

Last updated

Aug 22, 2020By 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

Mrs. Rhonda Susan Ambrose

Title

Administrator

Phone

(910) 298-5877

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992929475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1140",
            "city": "BEULAVILLE",
            "state": "NC",
            "postal_code": "285181140",
            "telephone_number": "910-298-5877",
            "fax_number": "910-298-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N NC 41 HWY",
            "city": "BEULAVILLE",
            "state": "NC",
            "postal_code": "285188633",
            "telephone_number": "910-298-5877",
            "fax_number": "910-298-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AMBROSE",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-298-5877",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-031-014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.