NPIMap

Organization Active NPI

Masonic Homes of California

  • Community/Behavioral Health Agency
  • Union City, CA
National Provider Identifier
1114111317
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MASONIC HOMES OF CALIFORNIA
Practice address
34400 Mission Blvd
Union City, CA 94587-3604
Phone
(510) 471-3434
Fax
(510) 476-6329
NPI assigned
Aug 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kimberly Rich
Title
Executive Director
Phone
(877) 488-6293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

34400 Mission Blvd
Union City, CA 94587-3604

Mailing address

34400 Mission Blvd
Union City, CA 94587-3604
Phone (510) 471-3434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200709000957 CA Part B Supplier - Clinic/Group Practice 4183625361 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Covina, CA; Union City, CA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Donald L Parker7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Masonic HomeUnion City, CA, CCN 555843 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 12, 2007
Oct 12, 2007
Oct 12, 2007
Citrus Heights Care CenterCovina, CA, CCN 555932 Skilled nursing facility 5% Or Greater Direct Ownership Interest Oct 1, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574380800000",
    "number": "1114111317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34400 MISSION BLVD",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945873604",
            "telephone_number": "510-471-3434",
            "fax_number": "510-476-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34400 MISSION BLVD",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945873604",
            "telephone_number": "510-471-3434",
            "fax_number": "510-476-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC HOMES OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2019-11-22",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "877-488-6293",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, CA

Sources for this page

Verify at the official NPI Registry.