Healthcare Provider Details

I. General information

NPI: 1083078588
Provider Name (Legal Business Name): MASON AND MASON GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 NASHVILLE RD
LANHAM MD
20706-4614
US

IV. Provider business mailing address

6916 NASHVILLE RD
LANHAM MD
20706-4614
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-4400
  • Fax:
Mailing address:
  • Phone: 301-552-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number16AL1114-A
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number16AL1114-A
License Number StateMD

VIII. Authorized Official

Name: KISHA MASON
Title or Position: OWNER/ALM
Credential:
Phone: 301-552-4400