Provider Demographics
NPI:1275836694
Name:VERITAS INCARE, LLC
Entity Type:Organization
Organization Name:VERITAS INCARE, LLC
Other - Org Name:MAGNOLIA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-895-1801
Mailing Address - Street 1:6933 CRUMPLER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1922
Mailing Address - Country:US
Mailing Address - Phone:662-895-1801
Mailing Address - Fax:552-895-1804
Practice Address - Street 1:1125 STRONG RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-8832
Practice Address - Country:US
Practice Address - Phone:850-875-1334
Practice Address - Fax:850-875-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9511310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility