Provider Demographics
NPI:1205486859
Name:MAGNOLIA MANOR OF LIBERTY COUNTY, INC.
Entity type:Organization
Organization Name:MAGNOLIA MANOR OF LIBERTY COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DANNY
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-931-5907
Mailing Address - Street 1:2001 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4715
Mailing Address - Country:US
Mailing Address - Phone:229-924-9352
Mailing Address - Fax:229-931-5999
Practice Address - Street 1:625 N COASTAL HWY # 17
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-3433
Practice Address - Country:US
Practice Address - Phone:912-884-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility