Provider Demographics
NPI:1730326380
Name:AUTUM YEAR FAMILY CARE HOME
Entity type:Organization
Organization Name:AUTUM YEAR FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEMOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAMI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CRNA
Authorized Official - Phone:803-448-2611
Mailing Address - Street 1:430 TYSONS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3805
Mailing Address - Country:US
Mailing Address - Phone:803-448-2611
Mailing Address - Fax:
Practice Address - Street 1:921 SURRY DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7140
Practice Address - Country:US
Practice Address - Phone:704-487-8261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE ANESTHESIA SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home