# MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Masonic Village at Sewickley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558615484
- **Authorized official:** MS. PAMELA FORMICA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (717) 367-1121

## Contact information

- **Practice address:** 1000 MASONIC DR, SEWICKLEY, PA 15143-2328
- **Practice address phone:** (412) 741-1400
- **Mailing address:** 1000 MASONIC DR, SEWICKLEY, PA 15143-2328
- **Mailing address phone:** (412) 741-1400
- **Mailing address fax:** (412) 741-0747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 221402 | PA | Yes |

## Other

- **Enumeration date:** 10/30/2012
- **Last updated:** 05/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0579 | SECURITY BLUE | PA |