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Organization
AUTUMN VIEW SENIOR DAY SERVICES, LLC
Active
Organization
AUTUMN VIEW SENIOR DAY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KWANTRELL D GREEN (CEO MANAGER)
(228) 343-9013
Entity
Organization
Contact information
Practice address
14321 DEDEAUX RD, SUITE 14, GULFPORT, MS 39503-3369
(228) 831-0048
(228) 831-0058
Mailing address
14321 DEDEAUX RD, SUITE 14, GULFPORT, MS 39503-3369
(228) 831-0048
(228) 831-0058
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251E00000X
Home Health Agency
—
NULL
251G00000X
Community Based Hospice Care Agency
—
NULL
Other
Enumeration date
06/25/2007
Last updated
07/17/2007
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