Organization
AUTUMN HOME CARE OF JOHNSTON CO., INC. III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS EDWARD WHITE (PRESIDENT)
(919) 965-3455
Entity
Organization
Contact information
Practice address
474 JERRY RD, SELMA, NC 27576-9248
(919) 965-3455
(919) 965-3455
Mailing address
474 JERRY RD, SELMA, NC 27576-9248
(919) 965-3455
(919) 965-3455
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL051001
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7806708
—
NC
Enumeration date
03/09/2007
Last updated
10/17/2012
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