# AUTUMN WOODS RESIDENTIAL HEALTH CARE FACILITY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205833175
- **Authorized official:** MRS. ELIZABETH J WOLF RN (ADMINISTRATOR/VICE PRESIDENT)
- **Authorized official phone:** (586) 574-3444

## Contact information

- **Practice address:** 29800 HOOVER RD, WARREN, MI 48093-3483
- **Practice address phone:** (158) 657-4344
- **Practice address fax:** (586) 574-9548
- **Mailing address:** 29800 HOOVER RD, WARREN, MI 48093-3483
- **Mailing address phone:** (158) 657-4344
- **Mailing address fax:** (586) 574-9548

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 504240 | MI | Yes |

## Other

- **Enumeration date:** 07/06/2005
- **Last updated:** 09/24/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2155021 | — | MI |