Healthcare Provider Details

I. General information

NPI: 1497416739
Provider Name (Legal Business Name): MAGNOLIA HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 N DEAN RD STE 500
AUBURN AL
36830-9454
US

IV. Provider business mailing address

890 N DEAN RD STE 500
AUBURN AL
36830-9454
US

V. Phone/Fax

Practice location:
  • Phone: 334-780-1475
  • Fax: 334-780-4700
Mailing address:
  • Phone: 334-780-1475
  • Fax: 334-780-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY J MANNING
Title or Position: OWNER
Credential:
Phone: 407-992-8494