Organization · NPI-2

1 Emily Way Opco LLC

Skilled Nursing Facility · West Hartford, CT

NPI number1972380921

StatusActive

Last updated in NPPESSep 13, 2023

Details

NPI: 1972380921
Entity type: Organization (NPI-2)
Legal business name: 1 Emily Way Opco LLC
Organization subpart: No
Enumeration date: Sep 13, 2023
Certification date: Sep 13, 2023
Last updated: Sep 13, 2023

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 West Hartford (Doing Business As)

Practice location

1 Emily Way
West Hartford, CT 06107-3136

Phone 732-358-6883

Mailing address

14c 53rd St
Brooklyn, NY 11232-2644

Phone 877-567-0402

Authorized official

Sam Stern
Cfo
8775670402

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