| NPI | 1073199840 |
|---|---|
| Doing Business As | AUTUMN LAKE HEALTHCARE AT GLADE VALLEY |
| Entity Type | Organization |
| Authorized Contact | SAM STERN CFO 877-567-0402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| 385H00000X Respite Care | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2021-03-22 |