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Organization
34 WILDWOOD AVE OPCO LLC
Active
Organization
34 WILDWOOD AVE OPCO LLC
Active
Other names
Autumn Lake Healthcare at Madison
Organization subpart
No
Provider details
NPI number
Authorized official
SAM STERN (CFO)
(877) 567-0402
Entity
Organization
Contact information
Practice address
34 WILDWOOD AVE, MADISON, CT 06443-2102
(732) 358-6883
Mailing address
14C 53RD ST, BROOKLYN, NY 11232-2644
(877) 567-0402
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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