NPIMap

Organization Active NPI

Masonic Homes of California

  • Community/Behavioral Health Agency
  • Covina, CA
National Provider Identifier
1295388106
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MASONIC HOMES OF CALIFORNIA
Doing business as
Masonic Homes of California - Covina
Practice address
1650 E Old Badillo St
Covina, CA 91724-3163
Phone
(626) 251-2200
NPI assigned
Jul 19, 2019
Organization subpart
Yes
Parent organization
MASONIC HOMES OF CALIFORNIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Authorized official

Name
Anna Millich, JD
Title
Associate General Counsel
Phone
(415) 929-3001

Specialties & licenses 1

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

Addresses

Primary practice location

1650 E Old Badillo St
Covina, CA 91724-3163

Mailing address

1650 E Old Badillo St
Covina, CA 91724-3163
Phone (626) 251-2200

Other names 1

  • Masonic Homes of California - Covina Doing business as

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
This NPI is an additional NPI on the enrollment
Practice locations: Covina, CA; Union City, CA

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
Part of
Donald L Parker

Other organizations with this tax ID 6

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

Locations

1111 California St
San Francisco, CA 94108

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1295388106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E OLD BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243163",
            "telephone_number": "626-251-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 E OLD BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243163",
            "telephone_number": "626-251-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC HOMES OF CALIFORNIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASONIC HOMES OF CALIFORNIA",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A",
        "authorized_official_last_name": "MILLICH",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "415-929-3001",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Homes of California - Covina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.