Provider Demographics
NPI:1659327708
Name:MAGNOLIA VILLAGE RETIREMENT COMMUNITY, LTD
Entity Type:Organization
Organization Name:MAGNOLIA VILLAGE RETIREMENT COMMUNITY, LTD
Other - Org Name:MAGNOLIA VILLIAGE SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES., VRC, INC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRANCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-929-0009
Mailing Address - Street 1:365 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8609
Mailing Address - Country:US
Mailing Address - Phone:330-335-1558
Mailing Address - Fax:330-335-2519
Practice Address - Street 1:365 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8609
Practice Address - Country:US
Practice Address - Phone:330-335-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601303Medicaid
OH365428Medicare ID - Type Unspecified
OH365428Medicare ID - Type Unspecified