Healthcare Provider Details

I. General information

NPI: 1891955324
Provider Name (Legal Business Name): AUTUMN HEALTH CARE OF THORNVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W CHURCH ST
NEWARK OH
43055-4946
US

IV. Provider business mailing address

156 W CHURCH ST
NEWARK OH
43055-4946
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-9198
  • Fax: 740-345-7737
Mailing address:
  • Phone: 740-345-9198
  • Fax: 740-345-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVE L. HITCHENS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 740-345-9198