AUTUMN HOUSE (NPI# 1831508241) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831508241 |
| Entity Type | Organization |
| Organization Name | AUTUMN HOUSE |
| Practice Address |
880 17th Ave S St Petersburg FL 33701-5716 |
| Practice Telephone | 7275644956 |
| Mailing Telephone | 7275644956 |
| Mailing Fax Number | 7278236163 |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2014-08-11 |
| Authorized Official Name | DANIEL PARKS (ADMINISTRATOR) |
| Authorized Official Telephone | 7275644956 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
AL6677 | FL | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962646836 | Autumn House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3902 Derbyshire Dr, Greensboro, NC 27410-2216 | 2009-04-23 |
| 1366857294 | Autumn House | Residential Treatment Facility, Emotionally Disturbed Children | 1301 3rd St Sw, Roanoke, VA 24016-5218 | 2014-06-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | AUTUMN HOUSE | 7555 Sw 157th, Beaverton, OR 97007 |
| System for Award Management (SAM) Entities | AUTUMN HOUSE | 500 Adair Blvd, Oklahoma City, OK 73110-2916 |
| Oregon Corporations, Companies and Business Names | AUTUMN HOUSE # 3 | 845 Nw 21st St, Redmond, OR 97756 |
| Colorado Business Entities | AUTUMN HOUSE CONDOMINIUM ASSOCIATION, INC. | 87 S. Washington St., #101, Denver, CO 80222 |
| Colorado Business Entities | Autumn House Homes, LLC | 2455 Sunstone Dr., Fort Collins, CO 80525 |
| Oregon Corporations, Companies and Business Names | AUTUMN HOUSE I, LLC | 2712 Willamina Ave, Forest Grove, OR 97116 |
| Washington State Corporations | AUTUMN HOUSE I, LLC | 13601 Nw 36th Ave, Vancouver, WA 98665 |
| Oregon Corporations, Companies and Business Names | AUTUMN HOUSE II, LLC | 7555 Sw 157th Ave, Beaverton, OR 97007 |
| Oregon Corporations, Companies and Business Names | AUTUMN HOUSE III, LLC | 17650 Sw Marty Ln, Beaverton, OR 97006 |
| Vermont Business Registrations | AUTUMN HOUSE INN, INC. | Jacksonville, VT 05342 |
| Street Address |
880 17TH AVE S |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33701-5716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514603 | Tien Thuy Hoang | Pharmacist | 875 Dr M.l.k. Jr St N, St. Petersburg, FL 33701 | 2020-10-06 |
| 1851920953 | Michelle Tedrowe | Student in an Organized Health Care Education/Training Program | Bayfront Health St Petersburg Family Care Center, 700 6th Street South, St. Petersburg, FL 33701 | 2020-04-02 |
| 1164070264 | Melissa Joy Fitzpatrick | Occupational Therapist | 239 14 Ave Ne, St Petersburg, FL 33701 | 2019-09-01 |
| 1841763091 | William Carpenter Scott | Dentist | 239 2nd Ave S # 100, St Petersburg, FL 33701 | 2019-01-09 |
| 1992289318 | Westminster Senior Services, Inc. | Registered Nurse | 830 North Shore Dr. Ne, St. Petersburg, FL 33701 | 2018-09-21 |
| 1265929780 | B&b Florida Eye Care Pllc | Optometrist | 1380 4th St N, St. Petersburg, FL 33701 | 2018-04-19 |
| 1730684895 | Loraine Marie Torres Garcia | Student in an Organized Health Care Education/Training Program | Bayfront Health St Petersburg, 700 6th Street South, St Petersburg, FL 33701 | 2018-03-29 |
| 1598267445 | Vincent Malik Dehili | Psychologist | 146 2nd Street North, Suite 305, St. Petersburg, FL 33701 | 2018-03-07 |
| 1770083073 | Megan Sanborn | Nurse Practitioner | 601 5th St S Ste 304, St Petersburg, FL 33701 | 2018-02-14 |
| 1174037089 | Julius Griffin | Licensed Practical Nurse | 1115 Highland St N, Apt B, Saint Petersburg, FL 33701 | 2017-11-30 |
| Find all providers in zip 33701 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437572104 | Tectrust Incorporated | Assisted Living Facility | 434 4th St N, St Petersburg, FL 33701-2804 | 2014-01-30 |
| 1043642606 | Adrian Manor | Assisted Living Facility | 2168 9th Ave N, St Petersburg, FL 33713-7134 | 2013-08-06 |
| 1285075986 | Loving Care of St Petersburg | Assisted Living Facility | 1001 9th St N, St Petersburg, FL 33701-1514 | 2013-07-10 |
| 1386944064 | Alcove Retirement Center IIi | Assisted Living Facility | 2801 4th St N, St Petersburg, FL 33704 | 2010-10-27 |
| 1770742231 | Everlasting Grace Assisted Living Inc. | Assisted Living Facility | 1325 4th St N, St Petersburg, FL 33701-1117 | 2008-06-09 |
| 1194900985 | Gulf Coast Jewish Family Services | Assisted Living Facility | 3180 66th St N, St Petersburg, FL 33710-3165 | 2007-12-31 |
| 1164475067 | Shrinathji, Inc | Assisted Living Facility | 2349 Central Ave, St Petersburg, FL 33713-8845 | 2006-05-19 |
| 1407238504 | Amelia Assisted Living Facility, Inc | Assisted Living Facility | 2135 40th Ave N, St Petersburg, FL 33714-4124 | 2015-06-24 |
| 1053746107 | Mental Health Group of Greater Tampa Bay | Assisted Living Facility | 2349 Central Ave, St Petersburg, FL 33713-8845 | 2013-09-09 |
| 1942518501 | The Peacekeepers' Den Inc. | Assisted Living Facility | 1325 4th St N, St Petersburg, FL 33701-1117 | 2010-09-16 |
| Find all providers in ST PETERSBURG | ||||
| City | ST PETERSBURG |
| Zip Code | 33701 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.