Organization
AUTUMN LEAVES, INC.
Active
Parent organization
AUTUMN LEAVES. INC
Other names
FOURTY FOURTH 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
1479 S 44TH ST, DECATUR, IL 62521-4323
(217) 422-2773
Mailing address
1479 S 44TH ST, DECATUR, IL 62521-4323
(217) 422-2773
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
38737
IL
Other
Enumeration date
03/06/2007
Last updated
01/23/2017
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