Organization · NPI-2

Autumn Corporation

Skilled Nursing Facility · Wilmington, NC

NPI number1073599635
StatusActive
Last updated in NPPESDec 19, 2022

Details

NPI
1073599635
Entity type
Organization (NPI-2)
Legal business name
Autumn Corporation
Organization subpart
Yes
Enumeration date
Dec 15, 2005
Certification date
Dec 19, 2022
Last updated
Dec 19, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing Facilitynh0595NCYes
311ZA0620X Custodial Care Facility, Adult Care Home––

Other names

  • Autumn Care Of Myrtle Grove (Doing Business As)

Practice location

5725 Carolina Beach Rd
Wilmington, NC 28412-2611

Phone 910-792-1455 · Fax 910-792-1492

Mailing address

23700 Commerce Park
Beachwood, OH 44122-5827

Phone 216-292-5706

Authorized official

William I. Weisberg
President
2162925706

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