225 Amity Rd Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

225 AMITY RD OPCO LLC

Doing business as

Autumn Lake Healthcare at Woodbridge

Practice address

225 Amity Rd
Woodbridge, CT 06525-2206

Phone

(732) 358-6883

NPI assigned

Sep 13, 2023

Last updated

Sep 13, 2023By the provider in NPPES

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

• Autumn Lake Healthcare at Woodbridge Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316724362. Details of each certification follow.

• CCN 075331 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 075331

Legal name

225 AMITY RD OPCO LLC

Doing business as

AUTUMN LAKE HEALTHCARE AT THE WILLOWS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 26, 1990

Last certification

Jan 10, 2024

Beds

90

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Apr 11, 2023 in DE

Enrollment address

225 Amity Rd
Woodbridge, CT 06525-2206

Nursing home name

AUTUMN LAKE HEALTHCARE AT THE WILLOWS

Affiliated entity

AUTUMN LAKE HEALTHCARE

Listed as

Autumn Lake Healthcare at the WillowsCCN 075331 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Feb 26, 1990

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9083.3 residents per day on average

Chain

Autumn Lake Healthcare59 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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.

• Channa Perera, M.D.

  • Internal Medicine Physician
  • West Haven, CT
  • NPI 1467458216

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 2

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

• 1 Emily Way Opco LLC

  dba Autumn Lake Healthcare at West Hartford

  • Skilled Nursing Facility
  • West Hartford, CT
  • NPI 1972380921

  Aut CT7 Holdings LLC, KC Derby CT Al Opco JV LLC

  CMS ownership
• 34 Wildwood Ave Opco LLC

  dba Autumn Lake Healthcare at Madison

  • Skilled Nursing Facility
  • Madison, CT
  • NPI 1750168704

  Aut CT7 Holdings LLC, KC Derby CT Al Opco JV LLC

  CMS ownership

Practitioners 1

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.

• Channa Perera, M.D.

  • Internal Medicine Physician
  • West Haven, CT
  • NPI 1467458216
  NPD (past)

Affiliated clinicians 4

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

• Sanjay K Aggarwal, M.D

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1912927658

  Nursing home

  Care Compare affiliation
• Alina R. Alfirii, MD

  • Internal Medicine Physician
  • Hamden, CT
  • NPI 1487687570

  Nursing home

  Care Compare affiliation
• Edmund F Caporaso, MD

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1285623538

  Nursing home

  Care Compare affiliation
• Sunita Chhabra, M.D.

  • Internal Medicine Physician
  • Hamden, CT
  • NPI 1568496552

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1316724362",
    "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",
            "telephone_number": "877-567-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 AMITY RD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065252206",
            "telephone_number": "732-358-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "225 AMITY RD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Lake Healthcare at Woodbridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• A Fresh Start LLC
• Khalilah Abdulrahim
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• Ramin Ahmadi, M.D.
• Lynn Albert

• Skilled Nursing Facility in Woodbridge, CT
• Providers in Woodbridge, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.