Provider Demographics
NPI:1639726102
Name:MASONIC HOMES OF CALIFORNIA
Entity Type:Organization
Organization Name:MASONIC HOMES OF CALIFORNIA
Other - Org Name:CITRUS HEIGHTS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SKILLED NURSING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-251-2230
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:626-251-2316
Mailing Address - Fax:
Practice Address - Street 1:161 S REEDER AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3129
Practice Address - Country:US
Practice Address - Phone:626-251-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASONIC HOMES OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility