Organization
MASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Active
Other names
Masonic Village at Elizabethtown
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA FORMICA (CHIEF FINANCIAL OFFICER)
(717) 367-1121
Entity
Organization
Contact information
Practice address
581 FREEMASON DR, ELIZABETHTOWN, PA 17022-3187
(717) 367-1121
(717) 367-5813
Mailing address
1 MASONIC DR, ELIZABETHTOWN, PA 17022-2199
(717) 367-1121
(717) 367-5813
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
122300000X
Dentist
—
—
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
213E00000X
Podiatrist
—
—
314000000X
Skilled Nursing Facility
Primary
131502
PA
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/30/2012
Last updated
05/01/2023
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