200 Whitman Avenue Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

200 WHITMAN AVENUE OPCO LLC

Doing business as

Autumn Lake Healthcare at Crystal Springs

Practice address

200 Whiteman Ave
Elkins, WV 26241-3400

Phone

(877) 567-0402

NPI assigned

May 10, 2021

Last updated

Mar 14, 2022By 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 Crystal Springs Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609450386. Details of each certification follow.

• CCN 515197 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 515197

Legal name

200 WHITMAN AVENUE OPCO LLC

Doing business as

AUTUMN LAKE HEALTHCARE AT CRYSTAL SPRINGS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 23, 2021

Last certification

Mar 6, 2025

Beds

84

Ownership / control type

Corporation

Organization structure

LLCProprietary

Incorporated

Apr 14, 2021 in WV

Enrollment address

200 Whiteman Ave
Elkins, WV 26241-3400

Nursing home name

AUTUMN LAKE HEALTHCARE AT CRYSTAL SPRINGS

Affiliated entity

AUTUMN LAKE HEALTHCARE

Listed as

Autumn Lake Healthcare at Crystal SpringsCCN 515197 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Dec 23, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8478.9 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 10

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.

• Catherine M. Chua, D.O.

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1295726685

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 1

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

• 499 Ferguson Road Opco LLC

  dba Nella's at Autumn Lake Healthcare

  • Skilled Nursing Facility
  • Elkins, WV
  • NPI 1205410883

  A & R Stern Family WV Holdings LLC, Nellas Opco Holdco LLC

  CMS ownership

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.

• Catherine M. Chua, D.O.

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1295726685
  NPD (past)
• Matthew Cupp, MD

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1457442709
  NPD (past)
• Carl High, MD

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1700808177
  NPD (past)

Affiliated clinicians 2

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

• Catherine M. Chua, D.O.

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1295726685

  Nursing home

  Care Compare affiliation
• Matthew Cupp, MD

  • Family Medicine Physician
  • Elkins, WV
  • NPI 1457442709

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1609450386",
    "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": "200 WHITEMAN AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413400",
            "telephone_number": "877-567-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "200 WHITMAN AVENUE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "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 Crystal Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 499 Ferguson Road Opco LLC (Nella's at Autumn Lake Healthcare)
• Susan R Abbott, FNP
• Sierra Abdon
• Rebecca Adams-Depew, FNP-BC
• Kathryn Ashley Adams

• Skilled Nursing Facility in Elkins, WV
• Providers in Elkins, WV by specialty
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.