Provider Demographics
NPI:1184854515
Name:MASONIC HOME OF DELAWARE, INC.
Entity Type:Organization
Organization Name:MASONIC HOME OF DELAWARE, INC.
Other - Org Name:HIGHFIELD MASONIC HOME OF DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GORING
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:302-994-4434
Mailing Address - Street 1:4800 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2559
Mailing Address - Country:US
Mailing Address - Phone:302-994-4434
Mailing Address - Fax:302-998-2722
Practice Address - Street 1:4800 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2559
Practice Address - Country:US
Practice Address - Phone:302-994-4434
Practice Address - Fax:302-998-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1093313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility