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NPI Code Detail

MEDICARE: AUTUMN CORPORATION

MEDICARE: AUTUMN CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311ZA0620XAdult Care Home Facility
2314000000XSkilled Nursing FacilityNH0595NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073599635
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN CORPORATION
Provider Business Mailing Address
First Line : 23700 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5827
Country : US
Telephone Number : 216-292-5706
Fax Number :
Provider Business Practice Location Address
First Line : 5725 CAROLINA BEACH RD
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2611
Country : US
Telephone Number : 910-792-1455
Fax Number : 910-792-1492
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM I. WEISBERG
Credential :
Telephone Number : 216-292-5706
Provider Enumeration Date : 12/15/2005
Last Update Date : 12/19/2022

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Directions to “AUTUMN CORPORATION ” Practice Location

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