Provider Demographics
NPI:1902587876
Name:MASONIC HOME OF FLORIDA
Entity Type:Organization
Organization Name:MASONIC HOME OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-822-3499
Mailing Address - Street 1:3201 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2299
Mailing Address - Country:US
Mailing Address - Phone:727-822-3499
Mailing Address - Fax:727-821-6775
Practice Address - Street 1:3201 1ST ST NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2299
Practice Address - Country:US
Practice Address - Phone:727-822-3499
Practice Address - Fax:727-821-6775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOST WORSHIPFUL GRAND LODGE OF FREE & ACCEPTED MASONS OF FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility