Provider Demographics
NPI:1790007110
Name:AUTUMN HEALTH CARE OF MT. VERNON
Entity type:Organization
Organization Name:AUTUMN HEALTH CARE OF MT. VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:1135 GAMBIER ROAD
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-392-1099
Mailing Address - Fax:740-392-2412
Practice Address - Street 1:1135 GAMBIER ROAD
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-392-1099
Practice Address - Fax:740-392-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
OH2630N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086748Medicaid
OH0086748Medicaid