Organization
3332 MAIN STREET OPCO LLC
Active
Other names
Autumn Lake Healthcare at Long View
Organization subpart
No
Provider details
NPI number
Authorized official
SAM STERN (CFO)
(877) 567-0402
Entity
Organization
Contact information
Practice address
3332 MAIN ST, MANCHESTER, MD 21102-1952
(410) 239-7139
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
05/09/2022
Last updated
08/16/2022
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