113 South Route 73 Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

113 SOUTH ROUTE 73 OPCO LLC

Practice address

113 Route 73
Voorhees, NJ 08043-9573

Phone

(856) 809-3500

NPI assigned

Dec 27, 2023

Organization subpart

No

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

Authorized official

Name

Sam Stern

Title

Cfo

Phone

(877) 567-0402

Specialties & licenses 3

Addresses

Other names 1

• The Subacute at Autumn Lake Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Skilled nursing facility certification: CCN 315513

Legal name

113 SOUTH ROUTE 73 OPCO LLC

Doing business as

THE SUBACUTE AT AUTUMN LAKE HEALTHCARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 7, 2013

Last certification

Oct 30, 2024

Beds

124

Ownership / control type

Individual

Organization structure

LLCProprietary

Incorporated

Feb 1, 2024 in NJ

Enrollment address

113 Route 73
Voorhees, NJ 08043-9573

Nursing home name

THE SUBACUTE AT AUTUMN LAKE HEALTHCARE

Affiliated entity

AUTUMN LAKE HEALTHCARE

Listed as

The Subacute at Autumn Lake HealthcareCCN 315513

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Feb 7, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

124119.5 residents per day on average

Chain

Autumn Lake Healthcare59 facilities in the chain

Penalties (3 years)

2Fines totaling $130,206

Processed by Care Compare on Aug 1, 2026.

Networks

• devoted network organization-34f14c1d-268c-4aac-9900-39ee1c9e5764Plans: DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) (H0413-003-000, H0413)

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 1

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

• Andrew Paul Pecora, D.O.

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1376637553

  Adp of the SNF

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Soumya Bollampally, DO

  • Geriatric Medicine (Internal Medicine) Physician
  • Voorhees, NJ
  • NPI 1205156445
  NPD (past)

Affiliated clinicians 1

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

• Zinnat A Chowdhury, M.D.

  • Internal Medicine Physician
  • Voorhees, NJ
  • NPI 1528048527

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1703635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1013786417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14C 53RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112322646",
            "telephone_number": "877-567-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 ROUTE 73",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080439573",
            "telephone_number": "856-809-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "113 SOUTH ROUTE 73 OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-27",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-567-0402"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Subacute at Autumn Lake Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.