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NPI Code Detail

MEDICARE: MAGNOLIA PLACE OF NEW BERN, LLC

MEDICARE: MAGNOLIA PLACE OF NEW BERN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living FacilityHAL-025-019NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477638856
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA PLACE OF NEW BERN, LLC
Provider Business Mailing Address
First Line : PO BOX 1487
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27285-1487
Country : US
Telephone Number : 336-595-1075
Fax Number :
Provider Business Practice Location Address
First Line : 3407 OAKS RD
Second Line :
City : NEW BERN
State : NC
Zip : 28560-2718
Country : US
Telephone Number : 252-633-1143
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : ROY L HOLT
Credential :
Telephone Number : 252-633-3455
Provider Enumeration Date : 10/26/2006
Last Update Date : 08/22/2020

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Directions to “MAGNOLIA PLACE OF NEW BERN, LLC ” Practice Location

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