Provider Demographics
NPI:1912301995
Name:CROMWELL OPERATIONS LLC
Entity Type:Organization
Organization Name:CROMWELL OPERATIONS LLC
Other - Org Name:AUTUMN LAKE HEALTHCARE AT CROMWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-358-6883
Mailing Address - Street 1:4260 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3351
Mailing Address - Country:US
Mailing Address - Phone:732-358-6883
Mailing Address - Fax:
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2308
Practice Address - Country:US
Practice Address - Phone:860-635-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2341314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075263Medicare Oscar/Certification