Provider Demographics
NPI:1851947634
Name:MAGNOLIA HEALTH SYSTEMS 57, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTH SYSTEMS 57, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-818-1240
Mailing Address - Street 1:9480 PRIORITY WAY WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1470
Mailing Address - Country:US
Mailing Address - Phone:317-818-1240
Mailing Address - Fax:317-818-1022
Practice Address - Street 1:1151 HUBERT CIR W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-5877
Practice Address - Country:US
Practice Address - Phone:765-558-8200
Practice Address - Fax:765-558-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility