Provider Demographics
NPI:1295388106
Name:MASONIC HOMES OF CALIFORNIA
Entity Type:Organization
Organization Name:MASONIC HOMES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLICH
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:415-929-3001
Mailing Address - Street 1:1650 E OLD BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3163
Mailing Address - Country:US
Mailing Address - Phone:626-251-2200
Mailing Address - Fax:
Practice Address - Street 1:1650 E OLD BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3163
Practice Address - Country:US
Practice Address - Phone:626-251-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASONIC HOMES OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health