# MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA

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

## Provider details

- **NPI number:** 1720332653
- **Authorized official:** MS. PAMELA FORMICA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (717) 367-1121

## Contact information

- **Practice address:** 581 FREEMASON DR, ELIZABETHTOWN, PA 17022-3187
- **Practice address phone:** (717) 367-1121
- **Practice address fax:** (717) 367-5813
- **Mailing address:** 1 MASONIC DR, ELIZABETHTOWN, PA 17022-2199
- **Mailing address phone:** (717) 367-1121
- **Mailing address fax:** (717) 367-5813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | — |
| 207W00000X | Ophthalmology Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |
| 314000000X | Skilled Nursing Facility | 131502 | PA | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

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