NPIMap

Organization Active NPI

Masonic Villages of the Grand Lodge of Pennsylvania

  • Skilled Nursing Facility
  • Lafayette Hill, PA
National Provider Identifier
1376897207
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
137102 Issued in PA
Legal business name
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Practice address
801 Ridge Pike
Lafayette Hill, PA 19444-1744
Phone
(610) 825-6100
Fax
(610) 828-2803
NPI assigned
Oct 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Authorized official

Name
Ms. Pamela Formica
Title
Chief Financial Officer
Phone
(717) 367-1121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 137102 PA Primary

Addresses

Primary practice location

801 Ridge Pike
Lafayette Hill, PA 19444-1744

Mailing address

581 Freemason Dr
Elizabethtown, PA 17022-3187
Phone (717) 367-1121

Other names 1

  • Masonic Village at Lafayette Hill Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130122000391 PA Part A Provider - Skilled Nursing Facility 9537136916 Practice locations: Lafayette Hill, PA

Skilled nursing facility certification: CCN 395818

Legal name
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Doing business as
MASONIC VILLAGES AT LAFAYETTE HILL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1990
Last certification
Sep 20, 2024
Beds
100 (50 certified)
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Grand Lodge of Pennsylvania
Organization structure
CorporationNon-profit
Incorporated
May 7, 1871 in PA
Enrollment address
801 Ridge Pike
Masonic Village at Lafayette Hill
Lafayette Hill, PA 19444-1799
Nursing home name
MASONIC VILLAGE AT LAFAYETTE HILL

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Masonic Village at Lafayette HillCCN 395818
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Mar 1, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4546.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0204144Masonic Village at Lafayette Hill801 Ridge Pike, Lafayette Hill, PA 19444Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Masonic Home of PA5 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.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

9303 Ridge Pike
Lafayette Hill, PA 19444

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert D Brink Individual Corporate DirectorBoard Member Dec 27, 2025
Lynn B Baker Individual Corporate DirectorBoard Member Dec 27, 2025
Todd R. Ockovic Individual Corporate DirectorBoard Member Dec 27, 2025
Frederic Collins Wheeler Individual Corporate DirectorBoard Member Dec 27, 2025
Brenda Spence Individual Corporate DirectorDirector of Resident Accounts Jan 1, 2017
Organization, Elizabethtown, PA Non-profit Adp of the SNF Jan 1, 2013
Robert J Cepielik Individual Corporate DirectorBoard Member Dec 27, 2025
William Kingsbury Individual Corporate OfficerCeo Dec 1, 2019
Paul Jeffrey Roup Individual Corporate DirectorBoard Member Dec 27, 2025
Organization, Houston, TX LLC, Medical staffing company, For-profit Adp of the SNF Sep 23, 2025
Thomas Bahney Individual Corporate DirectorBoard Member Dec 27, 2025
Robert Carl Snyder Individual Corporate DirectorBoard Member Dec 27, 2025
Stanley E. Saylor Individual Corporate DirectorBoard Member Dec 27, 2025
Eric T. Downs Individual Corporate DirectorBoard Member Dec 27, 2025
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Sep 23, 2025
Pamela Formica Individual Corporate OfficerCfo Jun 1, 2018
Operational/Managerial Control Jun 1, 2018
Adp of the SNF Jun 1, 2018
Adam C Heese Individual Corporate DirectorBoard Member Dec 27, 2025
Peter M. Kraus Individual Corporate DirectorBoard Member Dec 27, 2025
Denise Jones Individual Operational/Managerial Control May 6, 2024
Adp of the SNF May 6, 2024
Michael a Hirsch Individual Operational/Managerial Control Mar 25, 2022
Adp of the SNF Mar 25, 2022
Glenn D Miller Individual Corporate DirectorBoard Member Dec 27, 2025
Masonic Villages of the Grand Lodge of Pennsylvania Organization, Elizabethtown, PA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Adp of the SNF Jan 1, 2013

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Masonic Villages at ElizabethtownElizabethtown, PA, CCN 395560 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 2013
Jan 1, 2013
Masonic Village at WarminsterWarminster, PA, CCN 396054 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 2013
Jan 1, 2013
Masonic Village Home HealthElizabethtown, PA, CCN 398272 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 17, 2016
Masonic Village HospiceElizabethtown, PA, CCN 391721 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2017

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1376897207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "581 FREEMASON DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170223187",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 RIDGE PIKE",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441744",
            "telephone_number": "610-825-6100",
            "fax_number": "610-828-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "FORMICA",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "717-367-1121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "137102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Village at Lafayette Hill",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Masonic Village at Lafayette Hill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette Hill, PA

Sources for this page

Verify at the official NPI Registry.