Provider Demographics
NPI:1639379902
Name:MAGNOLIA MANOR MANAGEMENT INC
Entity Type:Organization
Organization Name:MAGNOLIA MANOR MANAGEMENT INC
Other - Org Name:MAGNOLIA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-293-0002
Mailing Address - Street 1:510 E BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-1506
Mailing Address - Country:US
Mailing Address - Phone:903-665-3903
Mailing Address - Fax:903-665-2410
Practice Address - Street 1:510 E BONHAM ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-1506
Practice Address - Country:US
Practice Address - Phone:903-665-3903
Practice Address - Fax:903-665-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility