MEDICARE: OVERLOOK MASONIC HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	314000000X	Skilled Nursing Facility	0749	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2222564301	OTHER	MA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	15030	OTHER	MA	FALLON COMMUNITY HEALTH
5	71-01273	OTHER	MA	UNITED HEALTHCARE/EVERCARE
6	905879	OTHER	MA	HARVARD PILGRIM HEALTH CARE

General Provider Information

NPI Number	:	1184613275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERLOOK MASONIC HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	88 MASONIC HOME RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507-1394
Country	:	US
Telephone Number	:	508-248-7344
Fax Number	:	508-248-7989

Provider Business Practice Location Address
First Line	:	88 MASONIC HOME RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507-1394
Country	:	US
Telephone Number	:	508-248-7344
Fax Number	:	508-248-7989

Authorized Official
Title or Position	:	CFO
Name	:	MS. PAMELA A JONES
Credential	:
Telephone Number	:	508-434-2412

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/01/2015

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Practice Location Address:

88 MASONIC HOME ROAD
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01507-1394

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1184608333 — OVERLOOK VISITING NURSE ASSOCIATION, INC.
Practice Location Address:

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Practice Location Address:

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1255516605 — MASONIC HEALTH SYSTEM OF MASSACHUSETTS INC.
Practice Location Address:

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01507-1394

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1427200559 — LISA BALDASSARRE
Practice Location Address:

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CHARLTON, MA
01507-1394

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1548413941 — MARTHA E. KAUPPINEN LMT
Practice Location Address:

88 MASONIC HOME RD , GUEST SUITE 5
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