Provider Demographics
NPI:1184613275
Name:OVERLOOK MASONIC HEALTH CENTER INC
Entity type:Organization
Organization Name:OVERLOOK MASONIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-434-2412
Mailing Address - Street 1:88 MASONIC HOME RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1394
Mailing Address - Country:US
Mailing Address - Phone:508-248-7344
Mailing Address - Fax:508-248-7989
Practice Address - Street 1:88 MASONIC HOME RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-248-7344
Practice Address - Fax:508-248-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
MA0749314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0918822Medicaid
MA2222564301OtherBLUE CROSS BLUE SHIELD
MA1720724OtherMEDICAID TRANSPORTATION
MA15030OtherFALLON COMMUNITY HEALTH
MA71-01273OtherUNITED HEALTHCARE/EVERCARE
MA905879OtherHARVARD PILGRIM HEALTH CARE
MA71-01273OtherUNITED HEALTHCARE/EVERCARE