Provider Demographics
NPI:1427351907
Name:AUTUMN EXTENDED CARE FACILITY, INC.
Entity type:Organization
Organization Name:AUTUMN EXTENDED CARE FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-345-9199
Mailing Address - Street 1:23 FORRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4057
Mailing Address - Country:US
Mailing Address - Phone:740-345-9919
Mailing Address - Fax:740-345-7737
Practice Address - Street 1:1433 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2263
Practice Address - Country:US
Practice Address - Phone:740-622-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3119244Medicaid
365090Medicare UPIN