Organization
AUTUMN AEGIS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH A MALANOWSKI (PRESIDENT)
(440) 989-5200
Entity
Organization
Contact information
Practice address
1130 TOWER BLVD, SUITE A, LORAIN, OH 44052-5235
(440) 282-6768
(440) 960-5612
Mailing address
3905 OBERLIN AVE, LORAIN, OH 44053-2838
(440) 989-5200
(440) 989-5273
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1039
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000156349
ANTHEM
OH
01
—
000000357077
ANTHEM PT
OH
01
—
000000357078
ANTHEM OT
OH
01
—
000000357079
ANTHEM ST
OH
05
—
0323733
—
OH
01
—
70023800
BLACK LUNG
OH
Enumeration date
10/24/2005
Last updated
03/19/2015
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