Provider Demographics
NPI:1003805284
Name:AUTUMN HEALTHCARE OF CAMBRIDGE, INC.
Entity Type:Organization
Organization Name:AUTUMN HEALTHCARE OF CAMBRIDGE, INC.
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 1:66731 OLD 21 RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8987
Mailing Address - Country:US
Mailing Address - Phone:740-432-7717
Mailing Address - Fax:740-432-5317
Practice Address - Street 1:66731 OLD 21 RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8987
Practice Address - Country:US
Practice Address - Phone:740-432-7717
Practice Address - Fax:740-432-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0397N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707940Medicaid
OH2707940Medicaid