Active NPI
115 East Melrose Opco LLC
Doing business as Autumn Lake Healthcare at Long Green
- Skilled Nursing Facility
- Baltimore, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- 115 EAST MELROSE OPCO LLC
- Doing business as
- Autumn Lake Healthcare at Long Green
- Practice address
- 115 E Melrose Ave
Baltimore, MD 21212-2945 - Phone
- (877) 567-0402
- NPI assigned
- Mar 22, 2021
- Last updated
- Mar 22, 2021
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | |||
| Skilled Nursing Facility | 314000000X | Primary | ||
| Respite Care | 385H00000X |
Addresses
Primary practice location
115 E Melrose Ave
Baltimore, MD 21212-2945
Mailing address
14C 53Rd St
Brooklyn, NY 11232-2644
Other names 1
- Autumn Lake Healthcare at Long Green
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210521001944 | MD | Part A Provider - Skilled Nursing Facility | 4688073794 | Practice locations: Baltimore, MD |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1043896814. Details of each certification follow.
Skilled nursing facility certification: CCN 215031
- Legal name
- 115 EAST MELROSE OPCO LLC
- Doing business as
- AUTUMN LAKE HEALTHCARE AT LONG GREEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 14, 1967
- Last certification
- Jul 31, 2024
- Beds
- 135
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Autumn Lake
- Organization structure
- LLC
- Incorporated
- Dec 29, 2020 in MD
- Enrollment address
- 115 E Melrose Ave
Baltimore, MD 21212-2945 - Nursing home name
- AUTUMN LAKE HEALTHCARE AT LONG GREEN
- Affiliated entity
- AUTUMN LAKE HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Autumn Lake Healthcare at Long Green
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 14, 1967
- Medicare certification status
- Active
- Certified beds
- 135
- Chain
- Autumn Lake Healthcare
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Brand Sonnenschine LLP | Operational/Managerial Control | May 1, 2021 | |
| Adp of the SNF | May 8, 2025 | ||
| Ziad K Mirza | Operational/Managerial Control | May 1, 2021 | |
| Adp of the SNF | May 1, 2021 | ||
| 115 East Melrose Holdco LLC | 5% Or Greater Direct Ownership Interest | May 1, 2021 | 100% |
| Accurate Staffing LLC | Operational/Managerial Control | May 1, 2021 | |
| Adp of the SNF | May 8, 2025 | ||
| Aryeh Stern | Indirect Ownership Interest | May 1, 2021 | 1% |
| Joseph Abramson | Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| A&R Stern Family MD1 Holdings LLC | 5% Or Greater Indirect Ownership Interest | May 1, 2021 | 74.15% |
| Hatzlacha Rabbah LLC | 5% Or Greater Indirect Ownership Interest | May 1, 2021 | 24.85% |
| Mark Schwartz | Corporate Officer | May 1, 2021 | |
| Operational/Managerial Control | May 1, 2021 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Towson, MD
- NPI 1225008915
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 18
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Autumn Lake Healthcare at Waugh Chapel
- Skilled Nursing Facility
- Gambrills, MD
- NPI 1912583683
A&R Stern Family MD1 Holdings LLC
-
dba Autumn Lake Healthcare at Catonsville
- Skilled Nursing Facility
- Catonsville, MD
- NPI 1194301960
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Perring Parkway
- Skilled Nursing Facility
- Baltimore, MD
- NPI 1497331268
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Calvert Manor
- Skilled Nursing Facility
- Rising Sun, MD
- NPI 1366188740
Accurate Staffing LLC
-
- Skilled Nursing Facility
- Crofton, MD
- NPI 1538736566
Accurate Staffing LLC, Brand Sonnenschine LLP
-
dba Autumn Lake Healthcare at Long View
- Skilled Nursing Facility
- Manchester, MD
- NPI 1952047326
Accurate Staffing LLC
-
dba Autumn Lake Healthcare at Ballenger Creek
- Skilled Nursing Facility
- Frederick, MD
- NPI 1386220143
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Spa Creek
- Skilled Nursing Facility
- Annapolis, MD
- NPI 1194301861
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Chesapeake Woods
- Skilled Nursing Facility
- Cambridge, MD
- NPI 1629654496
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Glade Valley
- Skilled Nursing Facility
- Walkersville, MD
- NPI 1073199840
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Homewood
- Skilled Nursing Facility
- Baltimore, MD
- NPI 1326624198
A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC
-
dba Autumn Lake Healthcare at Bradford Oaks
- Skilled Nursing Facility
- Clinton, MD
- NPI 1013593888
A&R Stern Family MD1 Holdings LLC, Accurate Staffing LLC, Brand Sonnenschine LLP, Hatzlacha Rabbah LLC
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Physician
- Baltimore, MD
- NPI 1366483919
-
- Internal Medicine Physician
- Linthicum Heights, MD
- NPI 1255376539
-
- Internal Medicine Physician
- Columbia, MD
- NPI 1255579744
-
- Internal Medicine Physician
- Roanoke, VA
- NPI 1013934181
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Acute Care Nurse Practitioner
- Catonsville, MD
- NPI 1588837090
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616371200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1616371200000",
"number": "1043896814",
"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": "112322644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 E MELROSE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212122945",
"telephone_number": "877-567-0402"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "115 EAST MELROSE OPCO LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-03-22",
"last_updated": "2021-03-22",
"certification_date": "2021-03-22",
"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": "Autumn Lake Healthcare at Long Green",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Baltimore, MD
- 1 Stop Recovery Services
- 1046 North Point, LLC (FutureCare NorthPoint)
- 1046 North Point, LLC (FutureCare NorthPoint)
- 115 East Melrose Avenue Operations LLC (Long Green Center)
- 115 East Melrose Avenue Operations LLC (Long Green Center)
- 16 Fusting Avenue Operations LLC (Catonsville Commons)
- 180 Degree Change Behavioral Health
- 180 Degree Change Behavioral Health LLC
- 180 Degree Change Behavioral Health LLC
- 180 Degree Change Behavioral Health LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.