Healthcare Provider Details

I. General information

NPI: 1346226040
Provider Name (Legal Business Name): AUTUMN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MULBERRY ST
SHALLOTTE NC
28470-4471
US

IV. Provider business mailing address

23700 COMMERCE PARK
BEACHWOOD OH
44122-5827
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-8858
  • Fax: 910-755-5059
Mailing address:
  • Phone: 216-292-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0456
License Number StateNC

VIII. Authorized Official

Name: WILLIAM I. WEISBERG
Title or Position: PRESIDENT
Credential:
Phone: 216-292-5706