Prospect House

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROSPECT HOUSE

Practice address

420 Reservoir Ave
Revere, MA 02151-5819

Phone

(781) 853-0005

NPI assigned

Apr 11, 2007

Organization subpart

No

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

Authorized official

Name

Shawn Bertram

Title

Executive Director

Phone

(781) 853-0005

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962625392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 RESERVOIR AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 RESERVOIR AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515819",
            "telephone_number": "781-853-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERTRAM",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "781-853-0005"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1905139",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Revere, MA
• Providers in Revere, MA by specialty
• Assisted Living Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.