Organization
AUTUMN VIEW OUTREACH AND DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWANTRELL GREEN (PRESIDENT)
(228) 547-4424
Entity
Organization
Contact information
Practice address
400 LEGG DR, GULFPORT, MS 39503-3352
(228) 547-4424
Mailing address
PO BOX 3162, GULFPORT, MS 39505-3162
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
01541356
MS
261QA0600X
Adult Day Care Clinic/Center
03873054
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01541356
—
MS
05
—
03873054
—
MS
Enumeration date
03/03/2014
Last updated
03/03/2014
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