Provider Demographics
NPI:1275597064
Name:TRUSTEES OF THE MASONIC HALL AND ASYLUM FUND
Entity Type:Organization
Organization Name:TRUSTEES OF THE MASONIC HALL AND ASYLUM FUND
Other - Org Name:MASONIC CARE COMMUNITY OF NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-798-4833
Mailing Address - Street 1:2150 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1788
Practice Address - Country:US
Practice Address - Phone:315-798-4800
Practice Address - Fax:315-798-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3202308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312267Medicaid
NY335541Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NYCA6019Medicare ID - Type UnspecifiedMED-B PROFESS. RAILROAD
NY81047AMedicare ID - Type UnspecifiedMED-B PROFESSIONAL GRP#