NPIMap

Organization Active NPI

7309 Second Avenue Opco LLC

Doing business as Autumn Lake Healthcare at Birch Manor

  • Skilled Nursing Facility
  • Sykesville, MD
National Provider Identifier
1669118980
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
7309 SECOND AVENUE OPCO LLC
Doing business as
Autumn Lake Healthcare at Birch Manor
Practice address
7309 2ND Ave
Sykesville, MD 21784-7531
Phone
(410) 795-1100
NPI assigned
May 10, 2022
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 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

7309 2ND Ave
Sykesville, MD 21784-7531

Mailing address

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

Other names 1

  • Autumn Lake Healthcare at Birch Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221026000392 MD Part A Provider - Skilled Nursing Facility 3375919798 Practice locations: Sykesville, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669118980. Details of each certification follow.

Skilled nursing facility certification: CCN 215136

Legal name
7309 SECOND AVENUE OPCO LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1981
Last certification
Jun 9, 2021
Beds
118
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Aug 1, 2022 in MD
Enrollment address
7309 2ND Ave
Sykesville, MD 21784-7531
Nursing home name
AUTUMN LAKE HEALTHCARE AT BIRCH MANOR
Affiliated entity
AUTUMN LAKE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumn Lake Healthcare at Birch ManorCCN 215136 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
118105.6 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 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
M Meisels Family Holdings LLC Organization, Brooklyn, NY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2022 40%
Adp of the SNF Aug 1, 2022
Brand Sonnenschine LLP Organization, Brooklyn, NY Adp of the SNF Aug 1, 2022
Mitul Dave Individual Operational/Managerial Control Jan 1, 2021
Adp of the SNF Aug 12, 1969
Accurate Staffing LLC Organization, Brooklyn, NY LLC, Medical staffing company Adp of the SNF Aug 1, 2022
Mark Schwartz Individual Corporate OfficerCorporate Officer Aug 1, 2022
Operational/Managerial Control Aug 1, 2022
Zina Kendell Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
7309 Second Avenue Holdco LLC Organization, Howell, NJ Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 100%
Adp of the SNF Aug 1, 2022
As Family MD4 Holdings LLC Organization, Howell, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2022 57%
Adp of the SNF Aug 1, 2022
7309 Second Avenue Propco LLC Organization, Howell, NJ Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Aug 1, 2022 100%
Adp of the SNF Aug 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 7

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": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1669118980",
    "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": "7309 2ND AVE",
            "city": "SYKESVILLE",
            "state": "MD",
            "postal_code": "217847531",
            "telephone_number": "410-795-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "7309 SECOND AVENUE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-08-16",
        "certification_date": "2022-06-13",
        "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 Birch Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Autumn Lake Healthcare at Birch Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sykesville, MD

Sources for this page

Verify at the official NPI Registry.