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NPI Code Detail

MEDICARE: AUTUMN CARE OF ALTAVISTA, LLC

MEDICARE: AUTUMN CARE OF ALTAVISTA, LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1316582133
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN CARE OF ALTAVISTA, LLC
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 : 1317 LOLA AVE
Second Line :
City : ALTAVISTA
State : VA
Zip : 24517-1352
Country : US
Telephone Number : 434-369-6651
Fax Number : 434-309-7254
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM I. WEISBERG
Credential :
Telephone Number : 216-292-5706
Provider Enumeration Date : 11/15/2019
Last Update Date : 12/15/2021

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