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General NPI Number Information
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NPI Number | 1790007110
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Entity Type | Organization
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Legal Business Name | AUTUMN HEALTH CARE OF MT. VERNON
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 1135 GAMBIER ROAD
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City | MT VERNON
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State | OH
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Zip | 43050
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Country | US
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Telephone | 740-392-1099
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Fax | 740-392-2412
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Provider Business Mailing Address
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Address Line | 1135 GAMBIER ROAD
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City | MT. VERNON
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State | OH
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Zip | 43050
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Country | US
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Telephone | 740-392-1099
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Fax | 740-392-2412
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN L. HITCHENS
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Credential |
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Telephone | 740-345-9199
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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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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2630N
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License Number State | OH
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