Organization
LIGHTHOUSE OF REVERE, INC.
Active
Other names
Lighthouse Nursing Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER E MARKS (ADMINISTRATOR)
(781) 286-3100
Entity
Organization
Contact information
Practice address
204 PROCTOR AVE, REVERE, MA 02151-4923
(781) 286-3100
(781) 286-4109
Mailing address
204 PROCTOR AVE, REVERE, MA 02151-4923
(781) 286-3100
(781) 286-4109
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0880
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0922226
—
MA
Enumeration date
07/07/2005
Last updated
07/24/2008
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