Organization Active NPI

405 River Street Operating Company, LLC

  • Skilled Nursing Facility
  • Mattapan, MA
National Provider Identifier
1609733757
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
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

Updated by the provider on Apr 15, 2026

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)CodeLicenseStatePrimary
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 Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2191849405 River Street Operating Company LLC405 River Street, Mattapan, MA 02126Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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.

Verify at the official NPI Registry.