Provider Demographics
NPI:1952637142
Name:GENERAL BAPTIST ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:GENERAL BAPTIST ASSISTED LIVING FACILITY
Other - Org Name:MAGNOLIA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-1020
Mailing Address - Street 1:1200 GORDON DUCKWORTH DR
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1911
Mailing Address - Country:US
Mailing Address - Phone:870-598-1020
Mailing Address - Fax:870-598-2196
Practice Address - Street 1:1200 GORDON DUCKWORTH DR
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1911
Practice Address - Country:US
Practice Address - Phone:870-598-1020
Practice Address - Fax:870-598-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR043310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility