34 Wildwood Ave Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

34 WILDWOOD AVE OPCO LLC

Practice address

34 Wildwood Ave
Madison, CT 06443-2102

Phone

(732) 358-6883

NPI assigned

Sep 13, 2023

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 Madison Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Skilled nursing facility certification: CCN 075405

Legal name

34 WILDWOOD AVE OPCO LLC

Doing business as

AUTUMN LAKE HEALTHCARE AT MADISON

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 16, 1994

Last certification

Nov 13, 2023

Beds

90

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Apr 11, 2023 in DE

Enrollment address

34 Wildwood Ave
Madison, CT 06443-2102

Nursing home name

AUTUMN LAKE HEALTHCARE AT MADISON

Affiliated entity

AUTUMN LAKE HEALTHCARE

Listed as

Autumn Lake Healthcare at MadisonCCN 075405

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 16, 1994

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

Penalties (3 years)

1Fines totaling $15,593

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 8

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.

• James J. Zumpano, M.D.

  • Internal Medicine Physician
  • Branford, CT
  • NPI 1437141363

  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

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

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

  CMS ownership
• 225 Amity Rd Opco LLC

  • Skilled Nursing Facility
  • Woodbridge, CT
  • NPI 1316724362

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

  CMS ownership

Affiliated clinicians 2

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

• Edmund F Caporaso, MD

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1285623538

  Nursing home

  Care Compare affiliation
• James J. Zumpano, M.D.

  • Internal Medicine Physician
  • Branford, CT
  • NPI 1437141363

  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": "1750168704",
    "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": "34 WILDWOOD AVE",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432102",
            "telephone_number": "732-358-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "34 WILDWOOD AVE 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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Lake Healthcare at Madison",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• A Family Chiropractic Center Inc
• Karen S Ablow, DMD
• Marjorie Adler, MS COUNSELING
• Tanya Adler, MS, LMSW
• Douglas P Agranov, O.D.

• All providers in Madison, CT
• 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.