NPIMap

Organization Active NPI

Masonic Villages of the Grand Lodge of Pennsylvania

Doing business as Masonic Village at Elizabethtown

  • Developmentally Disabled Services Day Training Agency
  • Elizabethtown, PA
National Provider Identifier
1730433343
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
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
Nov 5, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X Primary
Adult Day Care Clinic/Center 261QA0600X 261960 PA

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1730433343",
    "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": "2012-11-05",
        "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": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "PA",
            "license": "261960",
            "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

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.