Provider Demographics
NPI:1578336079
Name:MAGNOLIAS OF EUTAWVILLE
Entity Type:Organization
Organization Name:MAGNOLIAS OF EUTAWVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-579-2186
Mailing Address - Street 1:12488 OLD NUMBER SIX HWY
Mailing Address - Street 2:
Mailing Address - City:EUTAWVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29048-9167
Mailing Address - Country:US
Mailing Address - Phone:631-241-5738
Mailing Address - Fax:
Practice Address - Street 1:12488 OLD NUMBER SIX HWY
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-9167
Practice Address - Country:US
Practice Address - Phone:631-241-5738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility