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Organization
AUTUMN LEAVES, INC.
Active
Organization
AUTUMN LEAVES, INC.
Active
Parent organization
AUTUMN LEAVES. INC
Other names
HICKORY STREET PLACE
Organization subpart
Yes
Provider details
NPI number
Legal business name
AUTUMN LEAVES. INC
Authorized official
MR. DAVID MICHAEL JACOBUS (PRESIDENT)
(217) 763-2191
Entity
Organization
Contact information
Practice address
3905 E. HICKORY ST., DECATUR, IL 62521
(217) 429-8231
Mailing address
2576 N GREENWAY RD, CERRO GORDO, IL 61818-3022
(217) 763-2191
(217) 763-2101
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
37846
IL
Other
Enumeration date
03/05/2007
Last updated
01/23/2017
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