NPIMap

Organization Active NPI

Masonicare Health Center

  • Nursing Facility/Intermediate Care Facility
  • Wallingford, CT
National Provider Identifier
1356558472
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
119C Issued in CT
Legal business name
MASONICARE HEALTH CENTER
Practice address
22 Masonic Ave
Wallingford, CT 06492-3048
Phone
(203) 679-5900
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Authorized official

Name
Jon-Paul Venoit
Title
President & Ceo
Phone
(203) 679-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 119C CT Primary

Addresses

Primary practice location

22 Masonic Ave
Wallingford, CT 06492-3048

Mailing address

22 Masonic Ave
P. O. Box 70
Wallingford, CT 06492-3048
Phone (203) 679-5900

Other identifiers 1

IdentifierTypeStateIssuer
000091801MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
Opthalmology Department5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1356558472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "address_2": "P. O. BOX 70",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONICARE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "VENOIT",
        "authorized_official_first_name": "JON-PAUL",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "203-679-5000"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CT",
            "license": "119C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000091801",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.