MASONICARE HEALTH CENTER (NPI# 1629061593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629061593 |
| Entity Type | Organization |
| Organization Name | MASONICARE HEALTH CENTER |
| Practice Address |
22 Masonic Ave Wallingford CT 06492-3048 |
| Practice Telephone | 2036795900 |
| Mailing Telephone | 2036795900 |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2019-11-05 |
| Authorized Official Name | JON-PAUL VENOIT (PRESIDENT & CEO) |
| Authorized Official Telephone | 2036795000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QC1500X |
Clinic/Center Specialization: Community Health |
0075 | CT | Ambulatory Health Care Facilities |
| Y | 281P00000X | Chronic Disease Hospital | 11CD | CT | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 000070177 | 05 | |
| CT | 004025425 | 05 | |
| CT | BLUE CROSS | 082 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235500497 | Masonicare Health Center | Skilled Nursing Facility | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2015-10-14 |
| 1306212188 | Masonicare Health Center | Skilled Nursing Facility | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2015-08-17 |
| 1043690100 | Masonicare Health Center | Skilled Nursing Facility | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2015-06-04 |
| 1427250885 | Masonicare Health Center | Prosthetic/Orthotic Supplier | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2007-06-05 |
| 1356558472 | Masonicare Health Center | Nursing Facility/Intermediate Care Facility | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2007-05-17 |
| 1588638688 | Masonicare Health Center | Clinic/Center | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2006-02-15 |
| 1265425136 | Masonicare Health Center | Skilled Nursing Facility | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2005-08-25 |
| 1174516041 | Masonicare Health Center | Chronic Disease Hospital | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2005-08-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | MASONICARE HEALTH CENTER | C/o Murtha Cullina LLP, Cityplace I, 185 Asylum Street, Hartford, CT 06103-3469 |
| Street Address |
22 MASONIC AVE |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492-3048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780689836 | Masonic Healthcare Center | Pharmacy | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2005-06-16 |
| 1841805397 | Nicholas Metaxas | Physical Therapist | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2020-09-11 |
| 1841813102 | Elena Bochicchio | Physical Therapist | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2020-05-21 |
| 1245852151 | Annemieke Ausloos Martino | Physical Therapist | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2020-05-13 |
| 1457992216 | Alison Lorusso | Nurse Practitioner | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2019-10-03 |
| 1467014183 | Debbra Konopaske | Physical Therapy Assistant | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2019-07-02 |
| 1306305776 | Sarnia Scarlett | Occupational Therapy Assistant | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2019-03-15 |
| 1902364888 | Elizabeth Fox | Speech-Language Pathologist | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2019-03-09 |
| 1891253415 | Kathleen Robak | Occupational Therapy Assistant | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2019-03-04 |
| 1558831941 | Jeffrey Raymond Necio | Pharmacist | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2018-11-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891310215 | The Promptcare Companies, Inc. | Durable Medical Equipment & Medical Supplies | 101 Noth Plains Industrial Park, Suite B Building 2 Harvest Park, Wallingford, CT 06492 | 2020-06-11 |
| 1528692480 | Hilary Caitlin Sullivan | Nurse Practitioner | Park Avenue Medical, LLC, 85 Barnes Road, Suite 202, Wallingford, CT 06492 | 2020-02-28 |
| 1902370943 | Alicia Anne Eldridge | Student in an Organized Health Care Education/Training Program | 88 Cheshire Road, Wallingford, CT 06492 | 2019-01-13 |
| 1114409562 | Doreen Gail Barile | Pharmacist | 846 North Colony Road, Wallingford, CT 06492 | 2018-09-02 |
| 1942782354 | Brad Becker | Pharmacist | 846 North Colony Rd, Walingford, CT 06492 | 2018-08-31 |
| 1477041564 | Melissa A Fazzolari | Nurse Practitioner | 850 N Main Street Ext Ste B, Wallingford, CT 06492 | 2018-04-25 |
| 1992235857 | Karen Ann Meers | Behavioral Analyst | 29 North Plains Highway, Unit 15, Wallingford, CT 06492 | 2017-06-14 |
| 1992232698 | Chelsea Clements | Occupational Therapist | 87 Southwind Dr, Wallingford, CT 06492 | 2017-05-12 |
| 1659822369 | Sara Frawley | Naturopath | 850 N. Main Street Extention, Building 2 Suite 3c, Wallingford, CT 06492 | 2016-10-18 |
| 1083085518 | Energetic Spine Chiropractic | Chiropractor | 1271 South Broad St., Unit #11, Wallingford, CT 06492 | 2015-10-09 |
| Find all providers in zip 06492 | ||||
| Taxonomy Code | 281P00000X |
| Grouping | Hospitals |
| Classification | Chronic Disease Hospital |
| (1) A hospital including a physical plant and personnel that provides multidisciplinary diagnosis and treatment for diseases that have one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alteration; requires special training of the patient for rehabilitation; and/or may be expected to require a long period of supervision or care. In addition, patients require the safety, security, and shelter of these specialized inpatient or partial hospitalization settings. (2) A hospital that provides medical and skilled nursing services to patients with long-term illnesses who are not in an acute phase but who require an intensity of services not available in nursing homes. |
| Notes: Source: (1) Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174516041 | Masonicare Health Center | Chronic Disease Hospital | 22 Masonic Ave, Wallingford, CT 06492-3048 | 2005-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023446127 | Yale University | Chronic Disease Hospital | 333 Cedar St Fl 8, New Haven, CT 06510-3206 | 2013-10-29 |
| 1326190471 | Veterans Home and Health Care Facility | Chronic Disease Hospital | 287 West St, Rocky Hill, CT 06067-3501 | 2007-01-17 |
| 1689749079 | Hebrew Home and Hospital, Inc | Chronic Disease Hospital | 1 Abrahms Blvd, Pharmacy, West Hartford, CT 06117-1525 | 2006-11-21 |
| 1740261213 | Hebrew Home and Hospital, Inc | Chronic Disease Hospital | 1 Abrahms Blvd, West Hartford, CT 06117-1508 | 2005-11-10 |
| City | WALLINGFORD |
| Zip Code | 06492 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.