Provider Demographics
NPI:1104066968
Name:EMBASSY AUTUMNWOOD MANAGEMENT
Entity type:Organization
Organization Name:EMBASSY AUTUMNWOOD MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-706-3864
Mailing Address - Street 1:24579 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6338
Mailing Address - Country:US
Mailing Address - Phone:440-658-1458
Mailing Address - Fax:440-232-7113
Practice Address - Street 1:275 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1165
Practice Address - Country:US
Practice Address - Phone:330-927-2060
Practice Address - Fax:330-927-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1734N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
365563Medicare Oscar/Certification