Provider Demographics
NPI:1235110362
Name:MASONICARE PARTNERS HOME HEALTH AND HOSPICE, INC.
Entity Type:Organization
Organization Name:MASONICARE PARTNERS HOME HEALTH AND HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:203-679-5000
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-528-2273
Mailing Address - Fax:860-290-6795
Practice Address - Street 1:111 FOUNDERS PLZ
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3212
Practice Address - Country:US
Practice Address - Phone:860-528-2273
Practice Address - Fax:860-290-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
077120Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER