Provider Demographics
NPI:1417127895
Name:COTTONWOOD MANOR II
Entity Type:Organization
Organization Name:COTTONWOOD MANOR II
Other - Org Name:MAGNOLIA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-732-8473
Mailing Address - Street 1:41 SOUTH HALL RD
Mailing Address - Street 2:410 EAST FIRST STREET
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117
Mailing Address - Country:US
Mailing Address - Phone:601-732-8473
Mailing Address - Fax:
Practice Address - Street 1:410 E FIRST ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4204
Practice Address - Country:US
Practice Address - Phone:601-469-4389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS954310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility