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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