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General NPI Number Information
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NPI Number | 1295351682
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Entity Type | Organization
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Legal Business Name | AUTUMN COURT OPERATING COMPANY, LLC
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1925 E 4TH ST
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City | OTTAWA
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State | OH
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Zip | 45875-1540
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Country | US
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Telephone | 419-523-4370
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Fax |
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Provider Business Mailing Address
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Address Line | 5915 LANDERBROOK DR STE 350
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4063
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Country | US
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Telephone | 330-620-7828
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Fax | 216-428-2055
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | MR. JEFFREY DEGYANSKY
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Credential | LNHA
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Telephone | 330-620-7828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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