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MASONICARE
NPI 1104131283
Rehabilitation Hospital in Wallingford, CT

Active since August 12, 2010CLIA 07D2211030 · Waiver
22 MASONIC AVE, REHAB DEPARTMENT, WALLINGFORD, CT 06492(203) 679-5900(203) 679-6142 Get Directions Write a Review

NPPES record last updated: August 12, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Masonicare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASONICARE (NPI 1104131283) is a healthcare organization registered as a rehabilitation hospital in Wallingford, Connecticut and active in the NPI registry since August 2010. The organization holds a CLIA Waiver certificate valid through January 25, 2027 and lists Susan Fagan, Rehab Director, as its authorized official.

NPPES Registry Identity

NPI1104131283
Entity TypeOrganization
Primary Taxonomy283X00000X
Legal Business NameMASONICARE
Location Address22 MASONIC AVE, REHAB DEPARTMENTWallingford, CT 06492-3048
Mailing Address22 Masonic Ave, Rehab DepartmentWallingford, CT 06492-3048 · (203) 679-5900 · Fax (203) 679-6142
Phone(203) 679-5900
Fax(203) 679-6142
Organization SubpartNo
Authorized OfficialSusan FaganRehab Director · (203) 679-6247
Enumeration DateAugust 12, 2010
✔ NPI 1104131283 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRehabilitation HospitalHospitals
Taxonomy Code283X00000X
License✔ Licensed in CT · 003288
Definition
A hospital or facility that provides health-related, social and/or vocational services to disabled persons to help them attain their maximum functional capacity.
22 MASONIC AVE, Wallingford, CT 06492
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2211030

Masonicare At Ashlar Village Pond Ridge Assisted Living · Wallingford, CT
Active · expires Jan 25, 2027
CLIA Number07D2211030
Laboratory TypeAssisted Living Facility
Certificate Effective DateJanuary 26, 2025
Certificate Expiration DateJanuary 25, 2027
Laboratory DirectorOlena Korytnyuk
Laboratory Phone(860) 426-4631
Laboratory LocationMasonicare At Ashlar Village Pond Ridge Assisted Living74 Cheshire Rd, Wallingford, CT 06492
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISA ANN MURRAY SLP
Speech-Language Pathologist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-5409
MASONICARE HEALTH CENTER
Skilled Nursing Facility
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-5959
ANGELO MANDRY JR.
Occupational Therapy Assistant
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-6247
AMY F VUMBACK PT
Physical Therapist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-6273
MRS. RACHEL W PATA D.P.T
Physical Therapist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-6909
MS. JENNIFER LYNNE WILKOSZ MPT
Physical Therapist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-6909
MRS. MICHELLE LYNN GAWITT MS, CCC-SLP
Speech-Language Pathologist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-5409
MELISSA BENNETT OTR/L
Occupational Therapist
22 MASONIC AVE
WALLINGFORD, CT 06492
South Central Connecticut Planning Region (203) 679-5900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Masonicare's NPI number?

The NPI number for Masonicare is 1104131283. It was assigned to this organization in the NPPES registry on August 12, 2010.

Where is Masonicare located?

Masonicare is located at 22 Masonic Ave Rehab Department, Wallingford, CT 06492. The listed phone number is (203) 679-5900.

What is Masonicare's specialty?

The primary specialty registered for this NPI is Rehabilitation Hospital with taxonomy code 283X00000X.

Does Masonicare hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2211030) is associated with this NPI, valid through January 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Masonicare was last updated on August 12, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.