Provider Demographics
NPI:1225027774
Name:AUTUMN HEALTH CARE OF ZANESVILLE
Entity Type:Organization
Organization Name:AUTUMN HEALTH CARE OF ZANESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/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 1:1420 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6734
Mailing Address - Country:US
Mailing Address - Phone:740-452-4351
Mailing Address - Fax:740-450-1670
Practice Address - Street 1:1420 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6734
Practice Address - Country:US
Practice Address - Phone:740-452-4351
Practice Address - Fax:740-450-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0433314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2505364Medicaid
OH2795079Medicaid
OH365464Medicare ID - Type Unspecified