Provider Demographics
NPI:1073779161
Name:BROWNING MASONIC COMMUNITY
Entity type:Organization
Organization Name:BROWNING MASONIC COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-878-1808
Mailing Address - Street 1:8883 BROWNING DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-9757
Mailing Address - Country:US
Mailing Address - Phone:419-878-1808
Mailing Address - Fax:
Practice Address - Street 1:8883 BROWNING DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-9757
Practice Address - Country:US
Practice Address - Phone:419-878-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OHIO MASONIC HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2807823Medicaid