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General NPI Number Information
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NPI Number | 1710976220
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Entity Type | Organization
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Legal Business Name | MASONICARE HOME HEALTH AND HOSPICE, INC.
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 110 S TURNPIKE RD
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City | WALLINGFORD
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State | CT
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Zip | 06492-4342
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Country | US
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Telephone | 203-679-5200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | WALLINGFORD
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State | CT
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Zip | 06492-7001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | JON-PAUL VENOIT
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Credential |
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Telephone | 203-679-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | C841181
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | C841181
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License Number State | CT
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