Organization · NPI-2

2700 South Haven Road Opco LLC

Skilled Nursing Facility · Annapolis, MD

NPI number1134878283

StatusActive

Last updated in NPPESMar 23, 2022

Details

NPI: 1134878283
Entity type: Organization (NPI-2)
Legal business name: 2700 South Haven Road Opco LLC
Organization subpart: No
Enumeration date: Mar 23, 2022
Certification date: Mar 23, 2022
Last updated: Mar 23, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
314000000X	Skilled Nursing Facility	–	–	Yes
385H00000X	Respite Care	–	–
313M00000X	Nursing Facility/Intermediate Care Facility	–	–

Other names

Autumn Lake Healthcare At South Haven (Doing Business As)

Practice location

2700 Southaven Rd
Annapolis, MD 21401-7122

Phone 410-897-1300

Mailing address

14c 53rd St
Brooklyn, NY 11232-2644

Phone 877-567-0402

Authorized official

Sam Stern
Cfo
8775670402

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