Provider Demographics
NPI:1114111317
Name:MASONIC HOMES OF CALIFORNIA
Entity Type:Organization
Organization Name:MASONIC HOMES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-488-6293
Mailing Address - Street 1:34400 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3604
Mailing Address - Country:US
Mailing Address - Phone:510-471-3434
Mailing Address - Fax:510-476-6329
Practice Address - Street 1:34400 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3604
Practice Address - Country:US
Practice Address - Phone:510-471-3434
Practice Address - Fax:510-476-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health