Healthcare Provider Details

I. General information

NPI: 1003805284
Provider Name (Legal Business Name): AUTUMN HEALTHCARE OF CAMBRIDGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66731 OLD 21 RD
CAMBRIDGE OH
43725-8987
US

IV. Provider business mailing address

66731 OLD 21 RD
CAMBRIDGE OH
43725-8987
US

V. Phone/Fax

Practice location:
  • Phone: 740-432-7717
  • Fax: 740-432-5317
Mailing address:
  • Phone: 740-432-7717
  • Fax: 740-432-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0397N
License Number StateOH

VIII. Authorized Official

Name: MR. STEVE HITCHENS
Title or Position: CEO/OWNER
Credential:
Phone: 740-345-9199