Provider Demographics
NPI:1093519423
Name:AUTUMN COVE LLC
Entity type:Organization
Organization Name:AUTUMN COVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-BOADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:520-370-9770
Mailing Address - Street 1:2002 S CATHY AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8036
Mailing Address - Country:US
Mailing Address - Phone:520-747-0116
Mailing Address - Fax:844-921-1166
Practice Address - Street 1:2002 S CATHY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8036
Practice Address - Country:US
Practice Address - Phone:520-747-0116
Practice Address - Fax:844-921-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility