Provider Demographics
NPI:1033264973
Name:THE GRAND LODGE OF ANCIENT FREE AND ACCEPTED MASONS OF MARYLAND
Entity Type:Organization
Organization Name:THE GRAND LODGE OF ANCIENT FREE AND ACCEPTED MASONS OF MARYLAND
Other - Org Name:MARYLAND MASONIC HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:O NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMIN
Authorized Official - Phone:410-527-1111
Mailing Address - Street 1:300 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1300
Mailing Address - Country:US
Mailing Address - Phone:410-527-1111
Mailing Address - Fax:410-527-1379
Practice Address - Street 1:300 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1300
Practice Address - Country:US
Practice Address - Phone:410-527-1111
Practice Address - Fax:410-527-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03023313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility