# MASONIC HOMES OF KENTUCKY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154341923
- **Authorized official:** MR. TODD L. LACY (CFO)
- **Authorized official phone:** (502) 753-8802

## Contact information

- **Practice address:** 240 MASONIC HOME DR, MASONIC HOME, KY 40041-9000
- **Practice address phone:** (502) 897-4907
- **Practice address fax:** (502) 259-5290
- **Mailing address:** 240 MASONIC HOME DR, MASONIC HOME, KY 40041-9000
- **Mailing address phone:** (502) 897-4907
- **Mailing address fax:** (502) 259-5290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100225 | KY | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | 760006 | KY | — |

## Other

- **Enumeration date:** 07/21/2006
- **Last updated:** 10/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000054518 | ANTHEM | KY |
| 05 | — | 12502662 | — | KY |