Provider Demographics
NPI:1992794150
Name:AUTUMN HEALTHCARE OF COSHOCTON
Entity type:Organization
Organization Name:AUTUMN HEALTHCARE OF COSHOCTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-345-9199
Mailing Address - Street 1:1991 OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9370
Mailing Address - Country:US
Mailing Address - Phone:740-622-2074
Mailing Address - Fax:740-622-5501
Practice Address - Street 1:1991 OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9370
Practice Address - Country:US
Practice Address - Phone:740-622-2074
Practice Address - Fax:740-622-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2409N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473872Medicaid
OH2473872Medicaid