Healthcare Provider Details

I. General information

NPI: 1205880150
Provider Name (Legal Business Name): PROSPECT NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT ST
NORTH BENNINGTON VT
05257-9544
US

IV. Provider business mailing address

PO BOX 878
NORTH BENNINGTON VT
05257-0878
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-7144
  • Fax: 802-447-3044
Mailing address:
  • Phone: 802-447-7144
  • Fax: 802-447-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0270000217
License Number StateVT

VIII. Authorized Official

Name: MR. PETER J. MORRIS
Title or Position: PRESIDENT
Credential: MBA
Phone: 802-447-7144