Provider Demographics
NPI:1346499712
Name:MASON MANOR
Entity type:Organization
Organization Name:MASON MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PCHA
Authorized Official - Phone:724-353-9511
Mailing Address - Street 1:244 N PIKE RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9735
Mailing Address - Country:US
Mailing Address - Phone:724-353-9511
Mailing Address - Fax:
Practice Address - Street 1:244 N PIKE RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9735
Practice Address - Country:US
Practice Address - Phone:724-353-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA473980310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA473980OtherDEPT OF PUBLIC WELFARE