THE MANOR AT AUTUMN HILLS (CRG HEALTH CARE SYSTEM, INC.) NPI 1023291200

Assisted Living Facility in Niles, OH

NPI 1023291200 Organization Assisted Living Facility

About THE MANOR AT AUTUMN HILLS (CRG HEALTH CARE SYSTEM, INC.)

The Manor At Autumn Hills (crg Health Care System, Inc.) is a provider established in Niles, Ohio specializing in assisted living facility. The NPI number of The Manor At Autumn Hills (crg Health Care System, Inc.) is 1023291200 and was assigned on December 2007. The practitioner's primary taxonomy code is 310400000X with license number 34-001344 (OH). The provider is registered as an organization and their NPI record was last updated 14 years ago. The provider's is doing business as The Manor At Autumn Hills. The authorized official of this NPI record is Dr. Carl Russell Gillette D.o. (Owner, Medical Director)

NPI

1023291200

Provider NameTHE MANOR AT AUTUMN HILLS (CRG HEALTH CARE SYSTEM, INC.)
Provider Location Address2567 NILES VIENNA RD NILES, OH 44446
Provider Mailing Address2567 NILES VIENNA RD NILES, OH 44446
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameTHE MANOR AT AUTUMN HILLS
Other Name TypeDoing Business As (3)
Enumeration Date12-11-2007
Last Update Date12-11-2007


Primary Taxonomy

Taxonomy Code310400000X
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
License No.34-001344
License StateOH
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Business Address

THE MANOR AT AUTUMN HILLS
2567 NILES VIENNA RD
NILES, OH
ZIP 44446
Phone: (330) 652-6745
Fax: (330) 652-8743

Get Directions


Mailing Address

THE MANOR AT AUTUMN HILLS
2567 NILES VIENNA RD
NILES, OH
ZIP 44446
Phone: (330) 652-6745
Fax: (330) 652-8743



Authorized Official

Authorized Official NameDR. CARL RUSSELL GILLETTE D.O.
Authorized Official TitleOWNER, MEDICAL DIRECTOR
Authorized Official Phone(330) 652-6745

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1316542491 DANA MARIE GENSEL M.S., CF-SLP
Individual
Speech-Language Pathologist2567 NILES VIENNA RD
NILES, OH 44446
(216) 772-1030
1619572112 KATELYN EARLEY
Individual
Physical Therapist2567 NILES VIENNA RD
NILES, OH 44446
(216) 772-1030
1679178453 ALLISON COX PTA
Individual
Physical Therapy Assistant2567 NILES VIENNA RD
NILES, OH 44446
(216) 772-1030
1871757419MANOR AT AUTUMN HILLS INC
Organization
Assisted Living Facility2567 NILES VIENNA RD
NILES, OH 44446
(330) 652-6745
1952775512NILES RESIDENTIAL CARE, LLC
Organization
Assisted Living Facility2567 NILES VIENNA RD
NILES, OH 44446
(216) 772-1105

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.