Healthcare Provider Details

I. General information

NPI: 1922097476
Provider Name (Legal Business Name): AUTUMN HEALTH CARE OF NEWARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FORRY STREET
NEWARK OH
43055
US

IV. Provider business mailing address

17 FORRY STREET
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-8175
  • Fax: 740-345-9289
Mailing address:
  • Phone: 740-349-8175
  • Fax: 740-345-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5545
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2555R
License Number StateOH

VIII. Authorized Official

Name: MR. STEVE L. HITCHENS
Title or Position: PRESIDENT
Credential:
Phone: 740-345-9199