Provider Demographics
NPI:1124043286
Name:MAGNOLIA MANOR OF COLUMBUS, INC.
Entity Type:Organization
Organization Name:MAGNOLIA MANOR OF COLUMBUS, INC.
Other - Org Name:NURSING CENTER EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIBYL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-931-5904
Mailing Address - Street 1:PO BOX 9696
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9696
Mailing Address - Country:US
Mailing Address - Phone:706-324-0387
Mailing Address - Fax:706-324-0927
Practice Address - Street 1:2010 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-324-0387
Practice Address - Fax:706-324-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA240030314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00083047AMedicaid
GA00083047AMedicaid