Healthcare Provider Details

I. General information

NPI: 1184613275
Provider Name (Legal Business Name): OVERLOOK MASONIC HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MASONIC HOME RD
CHARLTON MA
01507-1394
US

IV. Provider business mailing address

88 MASONIC HOME RD
CHARLTON MA
01507-1394
US

V. Phone/Fax

Practice location:
  • Phone: 508-248-7344
  • Fax: 508-248-7989
Mailing address:
  • Phone: 508-248-7344
  • Fax: 508-248-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0749
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA A JONES
Title or Position: CFO
Credential:
Phone: 508-434-2412