Healthcare Provider Details

I. General information

NPI: 1427351907
Provider Name (Legal Business Name): AUTUMN EXTENDED CARE FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 WALNUT ST
COSHOCTON OH
43812-2263
US

IV. Provider business mailing address

23 FORRY ST
NEWARK OH
43055-4057
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-6411
  • Fax:
Mailing address:
  • Phone: 740-345-9919
  • Fax: 740-345-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L HITCHENS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 740-345-9199