Lighthouse of Revere, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0880 Issued in MA

Legal business name

LIGHTHOUSE OF REVERE, INC.

Doing business as

Lighthouse Nursing Care Center

Practice address

204 Proctor Ave
Revere, MA 02151-4923

Phone

(781) 286-3100

Fax

(781) 286-4109

NPI assigned

Jul 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roger E Marks

Title

Administrator

Phone

(781) 286-3100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lighthouse Nursing Care Center Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Saira Nisar, M.D.

  • Internal Medicine Physician
  • Fall River, MA
  • NPI 1114182680
  NPD (past)
• Mariko K Wong, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Everett, MA
  • NPI 1497984454
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1699772376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 PROCTOR AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514923",
            "telephone_number": "781-286-3100",
            "fax_number": "781-286-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 PROCTOR AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514923",
            "telephone_number": "781-286-3100",
            "fax_number": "781-286-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE OF REVERE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "781-286-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0922226",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Nursing Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guetchina Letang
• Rose Therese Letang
• Lorky Nercessian Libaridian, M.D.
• Wei Lien, MD
• Lifebridge Wellness Services, PLLC
• Lighthouse Operator LLC (Lighthouse Rehabilitation and Healthcare Center)
• Antonio Melendez Lim, MD
• Leigh Page Loftus, PTA
• Judy Tatiana Londono Patino, RN
• William Lopez

• Skilled Nursing Facility in Revere, MA
• Providers in Revere, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.