Provider Demographics
NPI:1437312857
Name:MASONIC HOME CARE
Entity Type:Organization
Organization Name:MASONIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MSSOC
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-525-3005
Mailing Address - Street 1:2655 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3617
Mailing Address - Country:US
Mailing Address - Phone:937-525-3006
Mailing Address - Fax:937-505-4005
Practice Address - Street 1:2655 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3617
Practice Address - Country:US
Practice Address - Phone:937-525-3006
Practice Address - Fax:937-505-4005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASONIC SENIOR SERVICES OF OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health