Provider Demographics
NPI:1619265105
Name:PROSPECT CONGREGATE HOUSING, INC.
Entity Type:Organization
Organization Name:PROSPECT CONGREGATE HOUSING, INC.
Other - Org Name:CHAI POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEREMA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:414-277-8815
Mailing Address - Street 1:1414 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3018
Mailing Address - Country:US
Mailing Address - Phone:414-277-8847
Mailing Address - Fax:414-276-4828
Practice Address - Street 1:1400 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3043
Practice Address - Country:US
Practice Address - Phone:414-289-9600
Practice Address - Fax:414-277-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10313310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility