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General NPI Number Information
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NPI Number | 1629061304
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Entity Type | Organization
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Legal Business Name | MASONICARE AT NEWTOWN INC
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 139 TODDY HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470
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Country | US
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Telephone | 203-364-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 139 TODDY HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470
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Country | US
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Telephone | 203-364-3110
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS GUTNER
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Credential |
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Telephone | 203-364-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1020C
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License Number State | CT
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