Provider Demographics
NPI:1497233860
Name:MAGDALENE HOUSE MINISTRIES INC.
Entity Type:Organization
Organization Name:MAGDALENE HOUSE MINISTRIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS, BA
Authorized Official - Phone:910-594-4860
Mailing Address - Street 1:609 WOODRUFF PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4549
Mailing Address - Country:US
Mailing Address - Phone:910-594-4860
Mailing Address - Fax:
Practice Address - Street 1:609 WOODRUFF PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4549
Practice Address - Country:US
Practice Address - Phone:910-594-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-29
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2020685701Medicaid