# AUTUMN VIEW SENIOR DAY SERVICES, LLC

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

## Provider details

- **NPI number:** 1720284839
- **Authorized official:** MR. KWANTRELL D GREEN (CEO MANAGER)
- **Authorized official phone:** (228) 343-9013

## Contact information

- **Practice address:** 14321 DEDEAUX RD, SUITE 14, GULFPORT, MS 39503-3369
- **Practice address phone:** (228) 831-0048
- **Practice address fax:** (228) 831-0058
- **Mailing address:** 14321 DEDEAUX RD, SUITE 14, GULFPORT, MS 39503-3369
- **Mailing address phone:** (228) 831-0048
- **Mailing address fax:** (228) 831-0058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 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