NPIMap

Organization Active NPI

56 West Frederick Opco LLC

  • Skilled Nursing Facility
  • Walkersville, MD
National Provider Identifier
1073199840
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
56 WEST FREDERICK OPCO LLC
Practice address
56 W Frederick St
Walkersville, MD 21793-8254
Phone
(877) 567-0402
NPI assigned
Mar 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X Primary
Respite Care 385H00000X

Addresses

Primary practice location

56 W Frederick St
Walkersville, MD 21793-8254

Mailing address

14C 53Rd St
Brooklyn, NY 11232-2644

Other names 1

  • Autumn Lake Healthcare at Glade Valley Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210521001075 MD Part A Provider - Skilled Nursing Facility 4789083874 Practice locations: Walkersville, MD

Skilled nursing facility certification: CCN 215313

Legal name
56 WEST FREDERICK OPCO LLC
Doing business as
AUTUMN LAKE HEALTHCARE AT GLADE VALLEY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 10, 1997
Last certification
Oct 15, 2021
Beds
124
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Autumn Lake Healthcare
Organization structure
LLCProprietary
Incorporated
Dec 29, 2020 in MD
Enrollment address
56 W Frederick St
Walkersville, MD 21793-8254
Nursing home name
AUTUMN LAKE HEALTHCARE AT GLADE VALLEY
Affiliated entity
AUTUMN LAKE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumn Lake Healthcare at Glade ValleyCCN 215313
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 10, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
124113.1 residents per day on average
Chain
Autumn Lake Healthcare59 facilities in the chain
Penalties (3 years)
1Fines totaling $37,265

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Brand Sonnenschine LLP Organization, Brooklyn, NY Adp of the SNF May 1, 2021
Hemen Shah Individual Operational/Managerial Control May 1, 2021
Adp of the SNF May 1, 2021
Accurate Staffing LLC Organization, Brooklyn, NY LLC, Medical staffing company Adp of the SNF May 1, 2021
Aryeh Stern Individual 5% Or Greater Indirect Ownership Interest May 1, 2021 1%
A&R Stern Family MD1 Holdings LLC Organization, Howell, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 1, 2021 74.15%
Cassandra P Weaver Individual Operational/Managerial Control May 1, 2021
Adp of the SNF May 1, 2021
Hatzlacha Rabbah LLC Organization, Howell, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 1, 2021 24.85%
Mark Schwartz Individual Operational/Managerial Control May 1, 2021
56 West Frederick Holdco LLC Organization, Howell, NJ Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 1, 2021 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 3

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

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": "1073199840",
    "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": "56 W FREDERICK ST",
            "city": "WALKERSVILLE",
            "state": "MD",
            "postal_code": "217938254",
            "telephone_number": "877-567-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "56 WEST FREDERICK 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 Glade Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walkersville, MD

Sources for this page

Verify at the official NPI Registry.