Organization
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Active
Other names
Masonic Village at Sewickley
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA FORMICA (CHIEF FINANCIAL OFFICER)
(717) 367-1121
Entity
Organization
Contact information
Practice address
1000 MASONIC DR, SEWICKLEY, PA 15143-2328
(412) 741-1400
Mailing address
1000 MASONIC DR, SEWICKLEY, PA 15143-2328
(412) 741-1400
(412) 741-0747
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
221402
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0579
SECURITY BLUE
PA
Enumeration date
10/30/2012
Last updated
05/01/2023
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