Provider Demographics
NPI:1295614907
Name:MAGNOLIA ADULT CARE LLC
Entity type:Organization
Organization Name:MAGNOLIA ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA SOCORRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-706-2195
Mailing Address - Street 1:2615 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE J #2138
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-706-2195
Mailing Address - Fax:
Practice Address - Street 1:2176 SOQUE RIVER DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8100
Practice Address - Country:US
Practice Address - Phone:770-706-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty