# AUTUMN HOUSE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ALBERTA PROFESSIONAL SERVICES, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962646836
- **Legal business name:** ALBERTA PROFESSIONAL SERVICES, INC.
- **Authorized official:** MR. DEREK MITCHELL BS, QP (OPERATIONS MANAGER)
- **Authorized official phone:** (336) 273-2640

## Contact information

- **Practice address:** 3902 DERBYSHIRE DR, GREENSBORO, NC 27410-2216
- **Practice address phone:** (336) 288-7360
- **Practice address fax:** (336) 273-6522
- **Mailing address:** 1000 REVOLUTION MILL DR, STUDIO \#2, GREENSBORO, NC 27405-5082
- **Mailing address phone:** (336) 273-2640
- **Mailing address fax:** (336) 273-6522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-041-874 | NC | Yes |

## Other

- **Enumeration date:** 04/23/2009
- **Last updated:** 04/23/2009