Provider Demographics
NPI:1871757419
Name:MANOR AT AUTUMN HILLS INC
Entity type:Organization
Organization Name:MANOR AT AUTUMN HILLS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:VINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-652-6745
Mailing Address - Street 1:2567 NILES VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-5401
Mailing Address - Country:US
Mailing Address - Phone:330-652-6745
Mailing Address - Fax:330-652-8743
Practice Address - Street 1:2567 NILES VIENNA RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-5401
Practice Address - Country:US
Practice Address - Phone:330-652-6745
Practice Address - Fax:330-652-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1847R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1847ROtherODH LICENSE