# AUTUMN CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Autumn Care of Mocksville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710962477
- **Authorized official:** WILLIAM I. WEISBERG (VICE PRESIDENT)
- **Authorized official phone:** (216) 292-5706

## Contact information

- **Practice address:** 1007 HOWARD ST, MOCKSVILLE, NC 27028-2548
- **Practice address phone:** (336) 751-3535
- **Practice address fax:** (336) 751-0028
- **Mailing address:** 26691 RICHMOND RD, BEDFORD HEIGHTS, OH 44146-1421
- **Mailing address phone:** (216) 292-5706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0221 | NC | Yes |

## Other

- **Enumeration date:** 12/14/2005
- **Last updated:** 01/21/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3415129 | — | NC |