525 Glenburn Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

525 GLENBURN OPCO LLC

Doing business as

Autumn Lake Healthcare at Chesapeake Woods

Practice address

525 Glenburn Ave
Cambridge, MD 21613-1414

Phone

(877) 567-0402

NPI assigned

Mar 22, 2021

Last updated

Mar 22, 2021By 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 Chesapeake Woods Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629654496. Details of each certification follow.

• CCN 215221 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 215221

Legal name

525 GLENBURN OPCO LLC

Doing business as

AUTUMN LAKE HEALTHCARE AT CHESAPEAKE WOODS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 25, 1990

Last certification

Mar 5, 2024

Beds

98

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Jan 12, 2021 in MD

Enrollment address

525 Glenburn Ave
Cambridge, MD 21613-1414

Nursing home name

AUTUMN LAKE HEALTHCARE AT CHESAPEAKE WOODS

Affiliated entity

AUTUMN LAKE HEALTHCARE

Listed as

Autumn Lake Healthcare at Chesapeake WoodsCCN 215221 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jul 25, 1990

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9894.3 residents per day on average

Chain

Autumn Lake Healthcare59 facilities in the chain

Penalties (3 years)

2Fines totaling $50,879

Processed by Care Compare on Aug 1, 2026.

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.

Owners & managing parties with NPI records 1

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

• Nicholas Nicholson Borodulia, M.D.

  • Family Medicine Physician
  • Fenwick Island, DE
  • NPI 1225004294

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 10

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

• 115 East Melrose Opco LLC

  dba Autumn Lake Healthcare at Long Green

  • Skilled Nursing Facility
  • Baltimore, MD
  • NPI 1043896814

  A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC

  CMS ownership
• 1221 Waugh Chapel Opco LLC

  dba Autumn Lake Healthcare at Waugh Chapel

  • Skilled Nursing Facility
  • Gambrills, MD
  • NPI 1912583683

  A&R Stern Family MD1 Holdings LLC

  CMS ownership
• 16 Fusting Opco LLC

  dba Autumn Lake Healthcare at Catonsville

  • Skilled Nursing Facility
  • Catonsville, MD
  • NPI 1194301960

  A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC

  CMS ownership
• 1801 Wentworth Opco 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

  CMS ownership
• 347 Ballenger Opco 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

  CMS ownership
• 35 Milkshake Opco 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

  CMS ownership
• 56 West Frederick Opco 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

  CMS ownership
• 6000 Bellona Opco LLC

  dba Autumn Lake Healthcare at Homewood

  • Skilled Nursing Facility
  • Baltimore, MD
  • NPI 1326624198

  A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC

  CMS ownership
• 7520 Surratts Opco LLC

  dba Autumn Lake Healthcare at Bradford Oaks

  • Skilled Nursing Facility
  • Clinton, MD
  • NPI 1013593888

  A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC

  CMS ownership
• 8720 Emge Opco LLC

  dba Autumn Lake Healthcare at Loch Raven

  • Skilled Nursing Facility
  • Baltimore, MD
  • NPI 1144806910

  A&R Stern Family MD1 Holdings LLC, Hatzlacha Rabbah LLC

  CMS ownership

Practitioners 5

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.

• Patricia A Johnson, D.O.

  • Family Medicine Physician
  • Cambridge, MD
  • NPI 1093822538
  NPD (past)
• Kinan Knaish, M.D.

  • Internal Medicine Physician
  • Parkville, MD
  • NPI 1821352113
  NPD (past)
• Ira Kurz, MD

  • Internal Medicine Physician
  • Cambridge, MD
  • NPI 1780663617
  NPD (past)
• Gary J Sprouse, M.D.

  • Internal Medicine Physician
  • Chester, MD
  • NPI 1255443727
  NPD (past)
• Nicholas Nicholson Borodulia, M.D.

  • Family Medicine Physician
  • Fenwick Island, DE
  • NPI 1225004294
  NPD (past)

Affiliated clinicians 3

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

• Kinan Knaish, M.D.

  • Internal Medicine Physician
  • Parkville, MD
  • NPI 1821352113

  Nursing home

  Care Compare affiliation
• Ira Kurz, MD

  • Internal Medicine Physician
  • Cambridge, MD
  • NPI 1780663617

  Nursing home

  Care Compare affiliation
• Nicholas Nicholson Borodulia, M.D.

  • Family Medicine Physician
  • Fenwick Island, DE
  • NPI 1225004294

  Nursing home

  Care Compare affiliation

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": "1629654496",
    "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": "525 GLENBURN AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216131414",
            "telephone_number": "877-567-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "525 GLENBURN 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": "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 Chesapeake Woods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 525 Glenburn Avenue Operations LLC (Chesapeake Woods Center)
• 525 Glenburn Avenue Operations LLC (Chesapeake Woods Center)
• A Time to Heal Physical Therapy, LLC
• Ahmed Abdel-Gawad, MD
• Shakira Abdulai, MPH
• Accurate Optical Co of Cambridge Inc
• Nikki Lee Adams, M.D.

• Skilled Nursing Facility in Cambridge, MD
• Providers in Cambridge, MD by specialty
• Skilled Nursing Facility in Maryland

• 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.

Verify at the official NPI Registry.