Autumn Corporation
Organization Active NPI Skilled Nursing Facility · Cornelius, NC
NPI 1376932889 · NPPES record last updated Dec 15, 2021
Key facts
- NPI
- 1376932889
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- NH0643 (NC)
- Legal business name
- AUTUMN CORPORATION
- Practice address
- 19530 Mt. Zion Pkwy
Cornelius, NC 28031 - Phone
- (704) 997-2970
- Fax
- (704) 997-2971
- NPI assigned
- Jan 21, 2015
- Organization subpart
- No
Authorized official
- Name
- William I. Weisberg
- Title
- President
- Phone
- (216) 292-5706
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 18
Corporate family (same tax ID) 38
Facilities with the same owner 122
Affiliated clinicians 1
-
Thad Aaron Clements, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Autumn Care of Cornelius
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 9, 2015
- Medicare certification status
- Active
- Certified beds
- 102 · 95.3 residents per day on average
- Chain
- Saber Healthcare Group
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Skilled nursing facility certification: CCN 345567
- Legal name
- AUTUMN CORPORATION
- Doing business as
- AUTUMN CARE OF CORNELIUS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 9, 2015
- Last certification
- May 2, 2024
- Beds
- 102
- Ownership / control type
- Corporation
- Multi-facility organization
- Saber Health Care Group
- Organization structure
- Corporation · Proprietary
- Incorporated
- Feb 25, 1977 in NC
- Enrollment address
- 19530 Mt Zion Pkwy
Cornelius, NC 28031-8398 - Nursing home name
- AUTUMN CARE OF CORNELIUS
- Affiliated entity
- SABER HEALTHCARE GROUP
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Saber Healthcare Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 1, 2016 | 100% |
| Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020) |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Ohi Asset NC Cornelius LP |
5% Or Greater Security Interest | Mar 1, 2016 | |
| Gregory Nicoluzakis |
Corporate Officer |
Mar 1, 2019 | |
| Adp of the SNF | Mar 1, 2019 | ||
| Darin Hopping |
Operational/Managerial Control |
Jun 21, 2021 | |
| SHG Management LLC |
Operational/Managerial Control | Sep 1, 2019 | |
| Adp of the SNF | Sep 1, 2019 | ||
| Saber Governance LLC |
Operational/Managerial Control | Sep 1, 2019 | 100% |
| BNV Dynasty LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 33% |
| Benjamin N Volpe |
Corporate Officer |
Mar 1, 2019 | |
| Corporate Director |
Mar 1, 2019 | 50% | |
| SHG Autumn, LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2016 | 100% |
| Citrin Cooperman Advisors LLC |
Adp of the SNF | Mar 1, 2016 | |
| Wiw Dynasty LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
| William I Weisberg |
Corporate Officer |
Mar 1, 2019 | |
| Corporate Director |
Mar 1, 2019 | 50% | |
| Adp of the SNF | Mar 1, 2016 | ||
| Walker & Associates PC |
Adp of the SNF | Dec 18, 2023 | |
| Cibc Bank USA |
Adp of the SNF | Mar 31, 2021 | |
| Decanted William I. Weisberg Family Dynasty Trust (Dated Sept 30, 2020 |
5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 67% |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Autumn Care of Biscoe |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Apr 1, 2017 May 6, 2026 |
| Village Care of King |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Autumn Care of Fayetteville |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2017 |
| Brunswick Health & Rehab Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2017 |
| Davie Nursing and Rehabilitation Center |
Skilled nursing facility | Direct Ownership Interest (100%) | Feb 19, 2019 |
| Autumn Care of Statesville |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 31, 2019 |
| Autumn Care of Altavista |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150212002148 | NC | Part a Provider - Skilled Nursing Facility | 9133117351 | Practice locations: Cornelius, NC |
National Provider Directory
- Tax ID family
- Autumn Corporation
Locations
19530 Zion Ave
Cornelius, NC 28031
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH0643 | NC | Yes |
Addresses
Primary practice location
19530 Mt. Zion Pkwy
Cornelius, NC 28031
Mailing address
23700 Commerce Park
Beachwood, OH 44122-5827
Phone (216) 292-5706
Other names
- Autumn Care of Cornelius
Other providers in Cornelius, NC
- Assurance Community Long Term Care LLP
- Athelas Counseling & Wellness, PLLC
- Tyler Alexander Auldredge
- Logan Joseph Aunon
- Autism Diagnostics Services of North Carolina, PC
- Amanda Ellen Averett
- Back to Health Chiropractic and Wellness Care, PLLC
- Gregory Thomas Badway
- Jodie Bailey
- Sarah Baird
All providers in Cornelius, NC · Skilled Nursing Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.