Provider Demographics
NPI:1619200326
Name:AUTUMN SPRINGS HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:AUTUMN SPRINGS HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CHINYELU
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-452-0853
Mailing Address - Street 1:6422 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2358
Mailing Address - Country:US
Mailing Address - Phone:614-367-1925
Mailing Address - Fax:614-367-1926
Practice Address - Street 1:6422 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2358
Practice Address - Country:US
Practice Address - Phone:614-367-1925
Practice Address - Fax:614-367-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-13
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299981251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3087645Medicaid
OH368318Medicare Oscar/Certification