Healthcare Provider Details

I. General information

NPI: 1184895435
Provider Name (Legal Business Name): AUTUMN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 BRINGLE FERRY RD
SALISBURY NC
28146-4776
US

IV. Provider business mailing address

1505 BRINGLE FERRY RD
SALISBURY NC
28146-4776
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-5885
  • Fax: 704-636-6974
Mailing address:
  • Phone: 704-637-5885
  • Fax: 704-636-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH0424
License Number StateNC

VIII. Authorized Official

Name: MR. SAM M MARSH
Title or Position: VICE PRESIDENT OF FINANCE
Credential: CPA
Phone: 252-443-6265