NPIMap

Organization Active NPI

Autumn Care of Statesville, LLC

  • Skilled Nursing Facility
  • Statesville, NC
National Provider Identifier
1730722240
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AUTUMN CARE OF STATESVILLE, LLC
Practice address
2001 Van Haven Dr
Statesville, NC 28625-4342
Phone
(704) 883-9700
NPI assigned
Oct 28, 2019
Organization subpart
Yes
Parent organization
SABER HEALTHCARE HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William I Weisberg
Title
President
Phone
(216) 292-5706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2001 Van Haven Dr
Statesville, NC 28625-4342

Mailing address

23700 Commerce Park
Beachwood, OH 44122-5827
Phone (216) 292-5706

Other names 1

  • Autumn Care of Statesville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200217004333 NC Part A Provider - Skilled Nursing Facility 9537596374 Practice locations: Statesville, NC

Skilled nursing facility certification: CCN 345511

Legal name
AUTUMN CARE OF STATESVILLE LLC
Doing business as
AUTUMN CARE OF STATESVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 19, 2001
Last certification
Apr 16, 2025
Beds
113 (103 certified)
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Oct 3, 2019 in NC
Enrollment address
2001 Van Haven Dr
Statesville, NC 28625-4342
Nursing home name
AUTUMN CARE OF STATESVILLE
Affiliated entity
SABER HEALTHCARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumn Care of StatesvilleCCN 345511
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 19, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10397.4 residents per day on average
Chain
Saber Healthcare Group126 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Saber Healthcare Holdings LLC Organization, Beachwood, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2019 100%
WWBV Holdings LLC Organization, Beachwood, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2019 100%
William I Weisberg Family Dynasty Trust (Dated June 1, 2011) Organization, Beachwood, OH 5% Or Greater Indirect Ownership Interest Jan 1, 2023 67%
Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020) Organization, Beachwood, OH 5% Or Greater Indirect Ownership Interest Jan 1, 2023 33%
Gregory Nicoluzakis Individual Corporate OfficerSecretary Dec 31, 2019
SHG Management LLC Organization, Beachwood, OH LLC Other Dec 31, 2019
Tambria Rabuck Individual W-2 Managing EmployeeAdministrator May 16, 2022 100%
Saber Governance LLC Organization, Beachwood, OH LLC, For-profit Operational/Managerial Control Dec 31, 2019 100%
BNV Dynasty LLC Organization, Beachwood, OH LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2023 33%
Benjamin N Volpe Individual Corporate OfficerVice President and Treasurer Dec 31, 2019
Corporate DirectorVice President and Treasurer Dec 31, 2019 50%
SHG Autumn, LLC Organization, Beachwood, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2019 100%
Wiw Dynasty LLC Organization, Beachwood, OH LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2023 67%
William I Weisberg Individual Corporate OfficerPresident Dec 31, 2019
Corporate DirectorPresident Dec 31, 2019 50%
Autumn Corporation Organization, Beachwood, OH Corporation, For-profit 5% Or Greater Direct Ownership Interest Dec 31, 2019 100%
SHH Holdings LLC Organization, Beachwood, OH LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2019 100%

Owners & managing parties with NPI records 19

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 19

Facilities with the same owner 116

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Autumn Care of Biscoe, LLC
    • Skilled Nursing Facility
    • Biscoe, NC
    • NPI 1255878245

    Autumn Corporation, Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC, WWBV Holdings LLC

    CMS ownership
  • Autumn Care of Fayetteville, LLC
    • Skilled Nursing Facility
    • Fayetteville, NC
    • NPI 1114463932

    Autumn Corporation, Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Nashville, NC
    • NPI 1053396788

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Wilmington, NC
    • NPI 1073599635

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, SHH Holdings LLC, Wiw Dynasty LLC, WWBV Holdings LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Marshville, NC
    • NPI 1093791337

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, SHH Holdings LLC, Wiw Dynasty LLC, WWBV Holdings LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Morganton, NC
    • NPI 1275519506

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, SHH Holdings LLC, Wiw Dynasty LLC, WWBV Holdings LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Shallotte, NC
    • NPI 1346226040

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, SHH Holdings LLC, Wiw Dynasty LLC, WWBV Holdings LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Cornelius, NC
    • NPI 1376932889

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Salisbury, NC
    • NPI 1508842295

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Waynesville, NC
    • NPI 1528044294

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Marion, NC
    • NPI 1609852375

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
  • Autumn Corporation
    • Skilled Nursing Facility
    • Saluda, NC
    • NPI 1639155302

    Benjamin N. Volpe Family Dynasty Trust (Dated December 29, 2020), BNV Dynasty LLC, Saber Governance LLC, Saber Healthcare Holdings LLC, SHG Autumn, LLC, Wiw Dynasty LLC

    CMS ownership
View all 116

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1730722240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23700 COMMERCE PARK",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225827",
            "telephone_number": "216-292-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAN HAVEN DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254342",
            "telephone_number": "704-883-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN CARE OF STATESVILLE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SABER HEALTHCARE HOLDINGS, LLC",
        "enumeration_date": "2019-10-28",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "WEISBERG",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-292-5706"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Care of Statesville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Autumn Care of Statesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.