Provider Demographics
NPI:1558508697
Name:GALION ASSISTED LIVING
Entity Type:Organization
Organization Name:GALION ASSISTED LIVING
Other - Org Name:MAGNOLIA TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-566-8885
Mailing Address - Street 1:1110 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1458
Mailing Address - Country:US
Mailing Address - Phone:419-462-3900
Mailing Address - Fax:419-462-3901
Practice Address - Street 1:1110 N MARKET ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1458
Practice Address - Country:US
Practice Address - Phone:419-462-3900
Practice Address - Fax:419-462-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2356R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility