Organization
AUTUMN HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL PARKS (ADMINISTRATOR)
(727) 564-4956
Entity
Organization
Contact information
Practice address
880 17TH AVE S, ST PETERSBURG, FL 33701-5716
(727) 564-4956
Mailing address
880 17TH AVE S, ST PETERSBURG, FL 33701-5716
(727) 564-4956
(727) 823-6163
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL6677
FL
Other
Enumeration date
08/11/2014
Last updated
08/11/2014
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