Provider Demographics
NPI:1679903736
Name:AUTUMN OF LIFE IN HOME CARE
Entity type:Organization
Organization Name:AUTUMN OF LIFE IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-217-6026
Mailing Address - Street 1:41 ACME RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2278
Mailing Address - Country:US
Mailing Address - Phone:207-217-6026
Mailing Address - Fax:207-217-6028
Practice Address - Street 1:41 ACME RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1543
Practice Address - Country:US
Practice Address - Phone:207-217-6026
Practice Address - Fax:207-217-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care