NPIMap

Organization Active NPI

Masonic Homes of California

Doing business as Masonic Home Pharmacy

  • Long Term Care Pharmacy
  • Union City, CA
National Provider Identifier
1639134950
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHY 41902 Issued in CA
Legal business name
MASONIC HOMES OF CALIFORNIA
Doing business as
Masonic Home Pharmacy
Practice address
34400 Mission Blvd
Union City, CA 94587-3604
Phone
(510) 429-6426
Fax
(510) 475-5697
NPI assigned
Apr 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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

Authorized official

Name
Mr. Yvonne M. Wong, RPH
Title
Director of Pharmacy
Phone
(510) 429-6426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PHY 41902 CA 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) 429-6426

Other names 1

  • Masonic Home Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150311000121 CA Part B Supplier - Mass Immunization (Roster Biller Only) 4183625361 Practice locations: 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).

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1639134950",
    "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": "510-429-6426",
            "fax_number": "510-475-5697"
        },
        {
            "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": "510-429-6426",
            "fax_number": "510-475-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONIC HOMES OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "510-429-6426",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "PHY 41902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union City, CA

Sources for this page

Verify at the official NPI Registry.