Healthcare Provider Details

I. General information

NPI: 1710976220
Provider Name (Legal Business Name): MASONICARE HOME HEALTH AND HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S TURNPIKE RD
WALLINGFORD CT
06492-4342
US

IV. Provider business mailing address

PO BOX 70
WALLINGFORD CT
06492-7001
US

V. Phone/Fax

Practice location:
  • Phone: 203-679-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC841181
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberC841181
License Number StateCT

VIII. Authorized Official

Name: JON-PAUL VENOIT
Title or Position: PRESIDENT CEO
Credential:
Phone: 203-679-6000