Provider Demographics
NPI:1992857890
Name:AUTUMN FALLS, INC.
Entity type:Organization
Organization Name:AUTUMN FALLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-581-8855
Mailing Address - Street 1:1016 E ASH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3854
Mailing Address - Country:US
Mailing Address - Phone:919-581-8855
Mailing Address - Fax:919-581-8855
Practice Address - Street 1:1016 E ASH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3854
Practice Address - Country:US
Practice Address - Phone:919-581-8855
Practice Address - Fax:919-581-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL096159320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness