Provider Demographics
NPI:1316005226
Name:MAGNOLIA HOLDINGS, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOLDINGS, LLC
Other - Org Name:OAK RIVER REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICKLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:3300 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3279
Mailing Address - Country:US
Mailing Address - Phone:530-365-0025
Mailing Address - Fax:530-365-0028
Practice Address - Street 1:3300 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3279
Practice Address - Country:US
Practice Address - Phone:530-365-0025
Practice Address - Fax:530-365-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316005226Medicaid
CALTC55147GMedicaid
CALTC55147GMedicaid