Provider Demographics
NPI:1811232259
Name:MASON HOUSE, LLC.
Entity Type:Organization
Organization Name:MASON HOUSE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-566-3721
Mailing Address - Street 1:8005 RENAULT DRIVE NORTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1325
Mailing Address - Country:US
Mailing Address - Phone:904-566-3721
Mailing Address - Fax:904-677-8005
Practice Address - Street 1:8005 RENAULT DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1325
Practice Address - Country:US
Practice Address - Phone:904-566-3721
Practice Address - Fax:904-677-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12198310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility