Provider Demographics
NPI:1215209648
Name:MAGNOLIA HEALTHCARE CENTER LLC GROUP
Entity Type:Organization
Organization Name:MAGNOLIA HEALTHCARE CENTER LLC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTTERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-527-4083
Mailing Address - Street 1:2642 N DUDNEY RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4305
Mailing Address - Country:US
Mailing Address - Phone:870-234-7000
Mailing Address - Fax:870-234-7168
Practice Address - Street 1:2642 N DUDNEY RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-4305
Practice Address - Country:US
Practice Address - Phone:870-234-7000
Practice Address - Fax:870-234-7168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA HEALTHCARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty