Provider Demographics
NPI:1942293071
Name:MASONIC HOMES OF CALIFORNIA
Entity Type:Organization
Organization Name:MASONIC HOMES OF CALIFORNIA
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-429-6402
Mailing Address - Street 1:1111 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2252
Mailing Address - Country:US
Mailing Address - Phone:415-776-7000
Mailing Address - Fax:415-776-7170
Practice Address - Street 1:34400 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3604
Practice Address - Country:US
Practice Address - Phone:510-471-3434
Practice Address - Fax:510-476-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 41902333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy