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General NPI Number Information
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NPI Number | 1891966156
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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 | 03/14/2008
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Last Update Date | 03/14/2008
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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 | 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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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | MR. SAM M MARSH
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Credential | CPA
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Telephone | 252-443-6265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH0599
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License Number State | NC
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