Provider Demographics
NPI:1205880150
Name:PROSPECT NURSING HOME, INC.
Entity type:Organization
Organization Name:PROSPECT NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:802-447-7144
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-0878
Mailing Address - Country:US
Mailing Address - Phone:802-447-7144
Mailing Address - Fax:802-447-3044
Practice Address - Street 1:20 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9544
Practice Address - Country:US
Practice Address - Phone:802-447-7144
Practice Address - Fax:802-447-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0270000217314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01440239Medicaid
VT0475041Medicaid
VT0475041Medicaid