Provider Demographics
NPI:1427045970
Name:BROOKWOOD-VICTORIA HEALTH CARE GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:BROOKWOOD-VICTORIA HEALTH CARE GENERAL PARTNERSHIP
Other - Org Name:MAGNOLIA HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:S
Authorized Official - Last Name:WITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:828-252-0099
Mailing Address - Street 1:455 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4827
Mailing Address - Country:US
Mailing Address - Phone:828-252-0099
Mailing Address - Fax:828-252-4186
Practice Address - Street 1:455 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4827
Practice Address - Country:US
Practice Address - Phone:828-252-0099
Practice Address - Fax:828-252-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0291314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405204Medicaid
345204Medicare ID - Type Unspecified