AUTUMN LEAVES, INC. (NPI# 1306975594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306975594 |
| Entity Type | Organization |
| Organization Name | AUTUMN LEAVES, INC. |
| Other Organization Name | BEACON STREET PLACE |
| Practice Address |
4838 Beacon Street Decatur IL 62521 |
| Mailing Address |
2576 N Greenway Rd Cerro Gordo IL 61818-3022 |
| Practice Telephone | 2174221761 |
| Practice Fax Number | 2174221760 |
| Mailing Telephone | 2177632191 |
| Mailing Fax Number | 2177632101 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2017-01-23 |
| Authorized Official Name | MR. DAVID MICHAEL JACOBUS (PRESIDENT) |
| Authorized Official Telephone | 2177632191 |
| Is Organization Subpart | Y |
| Parent Organization Name | AUTUMN LEAVES, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 38729 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| BEACON STREET PLACE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902936420 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 1479 S 44th St, Decatur, IL 62521-4323 | 2007-03-06 |
| 1891824892 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 3905 E. Hickory St., Decatur, IL 62521 | 2007-03-05 |
| Street Address |
4838 BEACON STREET |
| City | DECATUR |
| State | IL |
| Zip Code | 62521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326392432 | Extending Community Services Foundation | Intermediate Care Facility, Mentally Retarded | 3630 Emerald Pt, Decatur, GA 30034-5739 | 2012-10-29 |
| 1427336346 | Tranquility PCh, LLC | Intermediate Care Facility, Mentally Retarded | 3440 Rainbow Dr, Decatur, GA 30034-1807 | 2011-07-26 |
| 1336362300 | J & J Maupin Group Homes Inc. | Intermediate Care Facility, Mentally Retarded | 5310 E William Street Rd, Decatur, IL 62521-1874 | 2007-04-10 |
| 1487788311 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 729 S Webster St, Decatur, IL 62521-2672 | 2007-03-15 |
| 1295869121 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 3850 E Fulton Ave, Decatur, IL 62521-5088 | 2007-03-15 |
| 1851424998 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 805 E Johns Ave, Decatur, IL 62521-2681 | 2007-03-14 |
| 1902936420 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 1479 S 44th St, Decatur, IL 62521-4323 | 2007-03-06 |
| 1891824892 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 3905 E. Hickory St., Decatur, IL 62521 | 2007-03-05 |
| 1740404896 | J & J Maupin Group Homes Inc. | Intermediate Care Facility, Mentally Retarded | 5310 E William Street Rd, Decatur, IL 62521-1874 | 2007-04-12 |
| 1285857284 | Joe Jac Corp. | Intermediate Care Facility, Mentally Retarded | 5310 E William Street Rd, Decatur, IL 62521-1874 | 2007-04-10 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.