Provider Demographics
NPI:1376896258
Name:MAGNOLIA HEALTH SYSTEMS 41, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTH SYSTEMS 41, LLC
Other - Org Name:CROWNPOINTE OF CARMEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-818-1240
Mailing Address - Street 1:9480 PRIORITY WAY WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1470
Mailing Address - Country:US
Mailing Address - Phone:317-818-1240
Mailing Address - Fax:
Practice Address - Street 1:11610 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5600
Practice Address - Country:US
Practice Address - Phone:317-818-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120003091310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200928160CMedicaid