AUTUMN VILLAGE INC. NPI 1992929475

NPI Information

  • NPI: 1992929475
  • Provider Name: AUTUMN VILLAGE, INC.
  • Classification: Custodial Care Facility - 311ZA0620X
  • Specialization: Adult Care Home
  • Entity Type: Organization
  • CLIA Number: 34D2064901
  • Address: 235 N NC 41 HWY
    BEULAVILLE, NC
    ZIP 28518
  • Phone: (910) 298-5877

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NPI Details

AUTUMN VILLAGE, INC. is an adult care home custodial care facility in Beulaville, NC. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. AUTUMN VILLAGE, INC. NPI is 1992929475. The provider is registered as an organization entity type.

The provider's business location address is:

235 N NC 41 HWY
BEULAVILLE, NC
ZIP 28518-633
Phone: (910) 298-5877
Fax: (910) 298-5578

The provider's authorized official is Rhonda Susan Ambrose .
The authorized official title is Administrator and has the following contact phone number (910) 298-5877.

The CLIA number assigned to this NPI record is 34D2064901 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/13/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care HomeHAL-031-014NORTH CAROLINAYes

What is NPI?

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This page was last updated on: 3/30/2025

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