# AUTUMN LAKE LLC

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

## Provider details

- **NPI number:** 1518345214
- **Authorized official:** CRISTAL RILEY (COO)
- **Authorized official phone:** (225) 246-2740

## Contact information

- **Practice address:** 11758 S HARRELLS FERRY RD STE C, BATON ROUGE, LA 70816-2365
- **Practice address phone:** (225) 246-2740
- **Practice address fax:** (225) 367-4687
- **Mailing address:** 11758 S HARRELLS FERRY RD STE C, BATON ROUGE, LA 70816-2365
- **Mailing address phone:** (225) 246-2740
- **Mailing address fax:** (225) 367-4687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/13/2015
- **Last updated:** 08/26/2019