Active NPI
405 River Street Operating Company, LLC
- Skilled Nursing Facility
- Mattapan, MA
National Provider Identifier
1609733757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- 405 RIVER STREET OPERATING COMPANY, LLC
- Practice address
- 405 River St
Mattapan, MA 02126-2210 - Phone
- (617) 296-5585
- NPI assigned
- Jan 8, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffrey Rubin
- Title
- Authorized Official
- Phone
- (516) 413-6321
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
405 River St
Mattapan, MA 02126-2210
Mailing address
405 River St
Mattapan, MA 02126-2210
Phone (617) 296-5585
Other names 1
- Care Village at Mattapan
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D2191849 | 405 River Street Operating Company LLC | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Boston, MA
- NPI 1780871970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1767830400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776211200000",
"number": "1609733757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 RIVER ST",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262210",
"telephone_number": "617-296-5585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 RIVER ST",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262210",
"telephone_number": "617-296-5585"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "405 RIVER STREET OPERATING COMPANY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-01-08",
"last_updated": "2026-04-15",
"certification_date": "2026-04-15",
"status": "A",
"authorized_official_last_name": "RUBIN",
"authorized_official_first_name": "JEFFREY",
"authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "516-413-6321"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Care Village at Mattapan",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.