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Organization

PROSPECT HOUSE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHAWN BERTRAM (EXECUTIVE DIRECTOR)
(781) 853-0005
Entity
Organization

Contact information

Practice address
420 RESERVOIR AVE, REVERE, MA 02151-5819
(781) 853-0005
Mailing address
420 RESERVOIR AVE, REVERE, MA 02151-5819

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1905139
MA
Enumeration date
04/11/2007
Last updated
08/22/2020
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