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NPI Code Detail

MEDICARE: AUTUMN CORPORATION

MEDICARE: AUTUMN CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311Z00000XCustodial Care FacilityNH2483VA
2314000000XSkilled Nursing FacilityNH2483VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134105836
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN CORPORATION
Provider Business Mailing Address
First Line : 26691 RICHMOND RD
Second Line :
City : BEDFORD HEIGHTS
State : OH
Zip : 44146-1421
Country : US
Telephone Number : 216-292-5706
Fax Number :
Provider Business Practice Location Address
First Line : 1317 LOLA AVE
Second Line :
City : ALTAVISTA
State : VA
Zip : 24517-1352
Country : US
Telephone Number : 434-369-6651
Fax Number : 434-309-7254
Authorized Official
Title or Position : VICE PRESIDENT
Name : WILLIAM I. WEISBERG
Credential :
Telephone Number : 216-292-5706
Provider Enumeration Date : 12/15/2005
Last Update Date : 01/21/2019

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Directions to “AUTUMN CORPORATION ” Practice Location

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