=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902106784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUTUMN HEALTH CARE OF ADENA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2010
-----------------------------------------------------
Last Update Date | 11/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 U S ROUTE 250
-----------------------------------------------------
City | ADENA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43901-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-546-3620
-----------------------------------------------------
Fax | 740-546-4120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 U S ROUTE 250
-----------------------------------------------------
City | ADENA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43901-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-546-3620
-----------------------------------------------------
Fax | 740-546-4120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | STEVEN HITCHENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-345-9199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------