MASONIC VILLAGE AT ELIZABETHTOWN
NPI 1720332653
Skilled Nursing Facility in Elizabethtown, PA

Active since October 30, 2012
581 FREEMASON DR, ELIZABETHTOWN, PA 17022(717) 367-1121(717) 367-5813 Get Directions Write a Review

NPPES record last updated: May 1, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Masonic Village At Elizabethtown NPPES

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

MASONIC VILLAGE AT ELIZABETHTOWN (NPI 1720332653) is a healthcare organization registered as a skilled nursing facility in Elizabethtown, Pennsylvania and active in the NPI registry since October 2012. The organization lists Pamela Formica, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1720332653
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameMASONIC VILLAGES OF THE GRAND LODGE OF PENNSYLVANIA
Location Address581 FREEMASON DRElizabethtown, PA 17022-3187
Mailing Address1 Masonic DrElizabethtown, PA 17022-2199 · (717) 367-1121 · Fax (717) 367-5813
Fax(717) 367-5813
Organization SubpartNo
Authorized OfficialPamela FormicaChief Financial Officer · (717) 367-1121
Enumeration DateOctober 30, 2012
Last NPPES UpdateMay 1, 2023
NPPES CertifiedMay 1, 2023
✔ NPI 1720332653 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 8

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in PA · 131502
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Also ListedPsychologistTaxonomy 103T00000X
Also ListedDentistTaxonomy 122300000X
Also ListedOptometristTaxonomy 152W00000X
Also ListedOphthalmologyTaxonomy 207W00000X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedPodiatristTaxonomy 213E00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
581 FREEMASON DR, Elizabethtown, PA 17022

Other Names 1

Doing Business AsMasonic Village At Elizabethtown

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Masonic Village At Elizabethtown is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StatePennsylvaniaEnrollment IDO20130522000306Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Masonic Village At Elizabethtown, which bills Medicare for the services this clinician delivers.

Clinician (1)

Clinical Psychologist
NPI 1992955629
1 MASONIC DR
Elizabethtown, PA 17022
(717) 367-1121
✔ PECOS✔ Accepts Medicare1.3 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Masonic Villages Of The Grand Lodge Of Pennsylvania's NPI number?

The NPI number for Masonic Villages Of The Grand Lodge Of Pennsylvania is 1720332653. It was assigned to this organization in the NPPES registry on October 30, 2012. The provider is doing business as Masonic Village At Elizabethtown.

Where is Masonic Villages Of The Grand Lodge Of Pennsylvania located?

Masonic Villages Of The Grand Lodge Of Pennsylvania is located at 581 Freemason Dr, Elizabethtown, PA 17022. The listed phone number is (717) 367-1121.

What is Masonic Villages Of The Grand Lodge Of Pennsylvania's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Is Masonic Villages Of The Grand Lodge Of Pennsylvania enrolled in Medicare?

Yes. Masonic Villages Of The Grand Lodge Of Pennsylvania is registered in the Medicare PECOS enrollment system.

When is Masonic Villages Of The Grand Lodge Of Pennsylvania's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Pennsylvania, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Masonic Villages Of The Grand Lodge Of Pennsylvania?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Masonic Villages Of The Grand Lodge Of Pennsylvania. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Masonic Villages Of The Grand Lodge Of Pennsylvania was last updated on May 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.