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General NPI Number Information
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NPI Number | 1427034099
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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 | 12/15/2005
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 2001 VAN HAVEN DR
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City | STATESVILLE
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State | NC
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Zip | 28625-4342
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Country | US
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Telephone | 704-883-9700
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Fax | 704-883-9966
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Provider Business Mailing Address
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Address Line | 26691 RICHMOND RD
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City | BEDFORD HEIGHTS
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State | OH
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Zip | 44146-1421
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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 | VICE 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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0599
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License Number State | NC
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