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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
1313M00000XNursing Facility/Intermediate Care 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 : 1255502514
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN CORPORATION
Provider Business Mailing 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
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 : VICE PRESIDENT OF FINANCE
Name : MR. SAM M MARSH
Credential : CPA
Telephone Number : 252-443-6265
Provider Enumeration Date : 03/14/2008
Last Update Date : 03/14/2008

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Directions to “AUTUMN CORPORATION ” Practice Location

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