NPIMap

Organization Active NPI

Masonic Villages of the Grand Lodge of Pennsylvania

Doing business as Masonic Village at Elizabethtown

  • Skilled Nursing Facility
  • Elizabethtown, PA
National Provider Identifier
1720332653
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
131502 Issued in PA
Legal business name
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Doing business as
Masonic Village at Elizabethtown
Practice address
581 Freemason Dr
Elizabethtown, PA 17022-3187
Phone
(717) 367-1121
Fax
(717) 367-5813
NPI assigned
Oct 30, 2012
Last updated
May 1, 2023By the provider in NPPES
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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 131502 PA Primary
Nurse Practitioner 363L00000X
Psychologist 103T00000X
Dentist 122300000X
Optometrist 152W00000X
Ophthalmology Physician 207W00000X
Psychiatry Physician 2084P0800X
Podiatrist 213E00000X

Addresses

Primary practice location

581 Freemason Dr
Elizabethtown, PA 17022-3187

Mailing address

1 Masonic Dr
Elizabethtown, PA 17022-2199
Phone (717) 367-1121

Other names 1

  • Masonic Village at Elizabethtown Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130122000443 PA Part A Provider - Skilled Nursing Facility 9537136916 Practice locations: Elizabethtown, PA
O20130522000306 PA Part B Supplier - Clinic/Group Practice 9537136916 Receives reassigned benefits from 1 practitioner
Practice locations: Elizabethtown, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720332653. Details of each certification follow.

Skilled nursing facility certification: CCN 395560

Legal name
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Doing business as
MASONIC VILLAGES AT ELIZABETHTOWN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 15, 1983
Last certification
Dec 5, 2024
Beds
434
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
May 7, 1871 in PA
Enrollment address
One Masonic Drive
Masonic Village at Elizabethtown
Elizabethtown, PA 17022-2199
Nursing home name
MASONIC VILLAGE AT ELIZABETHTOWN

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 ElizabethtownCCN 395560 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Mar 15, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
434296.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Masonic Villages 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.

Ownership & related parties

All disclosed owners & managing parties 24

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
Matthew Mayo Individual Operational/Managerial Control May 6, 2024
Adp of the SNF May 6, 2024
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 Jun 1, 2018
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, Reading, PA 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
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Sep 23, 2025
Organization, Lancaster, PA LLC, Medical staffing company, For-profit Adp of the SNF Sep 23, 2025
Leigh a Deshong Individual Operational/Managerial Control May 6, 2024
Adp of the SNF May 6, 2024
Eric T. Downs Individual Corporate DirectorBoard Member Dec 27, 2025
Organization, Elizabethtown, PA Non-profit Adp of the SNF Jan 1, 2013
Organization, Mount Wolf, PA LLC, Medical staffing company, 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 May 6, 2024
Adam C Heese Individual Corporate DirectorBoard Member Dec 27, 2025
Peter M. Kraus Individual Corporate DirectorBoard Member Dec 27, 2025
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 Lafayette HillLafayette Hill, PA, CCN 395818 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 8

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.

Affiliated clinicians 9

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": "1720332653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MASONIC DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222199",
            "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": "581 FREEMASON DR",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170223187",
            "telephone_number": "717-367-1121",
            "fax_number": "717-367-5813"
        }
    ],
    "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": "131502",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Village at Elizabethtown",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Masonic Village at Elizabethtown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, PA

Sources for this page

Verify at the official NPI Registry.