Organization
AUTUMN CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM M. MARSH CPA (VICE PRESIDENT/CFO)
(252) 443-6265
Entity
Organization
Contact information
Practice address
320 N. MAIN ST, RICH SQUARE, NC 27869
(252) 539-4161
(252) 539-4361
Mailing address
PO BOX 7728, ROCKY MOUNT, NC 27804-0728
(252) 443-6265
(252) 443-2703
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
HAL066006
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7803072
CUSTODIAL - HA
NC
Enumeration date
12/21/2005
Last updated
08/22/2020
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