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General NPI Number Information
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NPI Number | 1093791337
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Entity Type | Organization
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Legal Business Name | AUTUMN CORPORATION
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 311 W PHIFER RD
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City | MARSHVILLE
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State | NC
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Zip | 28103
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Country | US
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Telephone | 704-624-6643
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Fax | 704-624-2022
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Provider Business Mailing Address
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Address Line | 23700 COMMERCE PARK
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City | BEACHWOOD
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State | OH
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Zip | 44122-5827
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Country | US
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Telephone | 216-292-5706
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM I. WEISBERG
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Credential |
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Telephone | 216-292-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0421
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License Number State | NC
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