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Organization
MASONICARE HEALTH CENTER
Active
Organization
MASONICARE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON-PAUL VENOIT (PRESIDENT & CEO)
(203) 679-5000
Entity
Organization
Contact information
Practice address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-5900
Mailing address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-5900
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
0075
CT
281P00000X
Chronic Disease Hospital
Primary
11CD
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000070177
—
CT
05
—
004025425
—
CT
01
—
082
BLUE CROSS
CT
Enumeration date
08/25/2005
Last updated
11/05/2019
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