Provider Demographics
NPI:1629402797
Name:MAGNOLIA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:PERSHA'
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-873-3163
Mailing Address - Street 1:4055 BRUSHYMILL CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8728
Mailing Address - Country:US
Mailing Address - Phone:770-873-3163
Mailing Address - Fax:
Practice Address - Street 1:4055 BRUSHYMILL CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8728
Practice Address - Country:US
Practice Address - Phone:770-873-3163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care