NPIMap

Organization Active NPI

1 Emily Way Opco LLC

Doing business as Autumn Lake Healthcare at West Hartford

  • Skilled Nursing Facility
  • West Hartford, CT
National Provider Identifier
1972380921
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
1 EMILY WAY OPCO LLC
Doing business as
Autumn Lake Healthcare at West Hartford
Practice address
1 Emily Way
West Hartford, CT 06107-3136
Phone
(732) 358-6883
NPI assigned
Sep 13, 2023
Last updated
Sep 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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
Skilled Nursing Facility 314000000X Primary
Respite Care 385H00000X

Addresses

Primary practice location

1 Emily Way
West Hartford, CT 06107-3136

Mailing address

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

Other names 1

  • Autumn Lake Healthcare at West Hartford Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240116001599 CT Part A Provider - Skilled Nursing Facility 6103278148 Practice locations: West Hartford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972380921. Details of each certification follow.

Skilled nursing facility certification: CCN 075407

Legal name
1 EMILY WAY OPCO LLC
Doing business as
AUTUMN LAKE HEALTHCARE AT WEST HARTFORD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 3, 1995
Last certification
Feb 6, 2024
Beds
75
Ownership / control type
Corporation
Multi-facility organization
Autumn Lake Healthcare
Organization structure
LLCProprietary
Incorporated
Apr 11, 2023 in DE
Enrollment address
1 Emily Way
West Hartford, CT 06107-3136
Nursing home name
AUTUMN LAKE HEALTHCARE AT WEST HARTFORD
Affiliated entity
AUTUMN LAKE HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumn Lake Healthcare at West HartfordCCN 075407 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 3, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7567.4 residents per day on average
Chain
Autumn Lake Healthcare59 facilities in the chain
Penalties (3 years)
1Fines totaling $24,453

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 Operational/Managerial Control Nov 28, 2023
Adp of the SNF Mar 28, 2025
Accurate Staffing LLC Organization, Brooklyn, NY LLC Operational/Managerial Control Nov 28, 2023
Adp of the SNF Mar 28, 2025
Philip J Karanian Individual Operational/Managerial Control Nov 28, 2023
Adp of the SNF Nov 28, 2023
Mark Schwartz Individual Corporate OfficerCorporate Officer Nov 28, 2023
Operational/Managerial Control Nov 28, 2023
Aut CT7 Holdings LLC Organization, Howell, NJ Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 28, 2023 100%
KC Derby CT Al Opco JV LLC Organization, New York, NY Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Nov 28, 2023 100%
Christal Altius Individual Operational/Managerial Control Nov 28, 2023
Adp of the SNF Nov 28, 2023

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 11

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1972380921",
    "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": "1 EMILY WAY",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061073136",
            "telephone_number": "732-358-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1 EMILY WAY 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 West Hartford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.