MEDICARE: MASONICARE HOME HEALTH AND HOSPICE, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1679168355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASONICARE HOME HEALTH AND HOSPICE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-7001
Country	:	US
Telephone Number	:	203-678-7853
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 BEACH ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-2784
Country	:	US
Telephone Number	:	888-332-0033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	JON-PAUL VENOIT
Credential	:
Telephone Number	:	203-679-6000

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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