NPIMap

Organization Active NPI

313 Hospital Drive Opco LLC

Doing business as Autumn Lake Healthcare at Baltimore Washington

  • Skilled Nursing Facility
  • Glen Burnie, MD
National Provider Identifier
1588313647
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
313 HOSPITAL DRIVE OPCO LLC
Doing business as
Autumn Lake Healthcare at Baltimore Washington
Practice address
313 Hospital Dr
Glen Burnie, MD 21061-5803
Phone
(410) 761-1222
NPI assigned
Mar 23, 2022
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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 NU
Skilled Nursing Facility 314000000X NU Primary
Respite Care 385H00000X NU

Addresses

Primary practice location

313 Hospital Dr
Glen Burnie, MD 21061-5803

Mailing address

14C 53Rd St
Brooklyn, NY 11232-2644
Phone (877) 567-0402

Other names 1

  • Autumn Lake Healthcare at Baltimore Washington Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220707003464 MD Part A Provider - Skilled Nursing Facility 2264812221 Practice locations: Glen Burnie, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588313647. Details of each certification follow.

Skilled nursing facility certification: CCN 215316

Legal name
313 HOSPITAL DRIVE OPCO LLC
Doing business as
AUTUMN LAKE HEALTHCARE AT BALTIMORE WASHINGTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 4, 1997
Last certification
Sep 9, 2024
Beds
129
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Jun 1, 2022 in MD
Enrollment address
313 Hospital Dr
Glen Burnie, MD 21061-5803
Nursing home name
AUTUMN LAKE HEALTHCARE AT BALTIMORE WASHINGTON
Affiliated entity
AUTUMN LAKE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumn Lake Healthcare at Baltimore WashingtonCCN 215316 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 4, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
129103.7 residents per day on average
Chain
Autumn Lake Healthcare59 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Brand Sonnenschine LLP Organization, Brooklyn, NY Adp of the SNF Jun 1, 2022
Accurate Staffing LLC Organization, Brooklyn, NY LLC, Medical staffing company Adp of the SNF Jun 1, 2022
A&R Stern Family MD7 LLC Organization, Howell, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 1, 2022 100%
Calvin E Vain Individual Operational/Managerial Control Jun 1, 2022
Adp of the SNF Jun 1, 2022
313 Hospital Drive Holdco LLC Organization, Howell, NJ Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2022 100%
Mark Schwartz Individual Operational/Managerial Control Jun 1, 2022
Mohit S Negi Individual Operational/Managerial Control Jun 1, 2022
Adp of the SNF Jun 1, 2022

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 5

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 2

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": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1588313647",
    "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": "313 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-761-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "313 HOSPITAL DRIVE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "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 Baltimore Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.