Basic Information
| Provider Information | |||||||||
| NPI: | 1104066968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBASSY AUTUMNWOOD MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24579 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441466338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406581458 | ||||||||
| FaxNumber: | 4402327113 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 E SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | RITTMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442701165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309272060 | ||||||||
| FaxNumber: | 3309274501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | HAYLEY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | ATTORNEY | ||||||||
| AuthorizedOfficialTelephone: | 2167063864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1734N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.