Healthcare Provider Details

I. General information

NPI: 1649926114
Provider Name (Legal Business Name): MAGNOLIA RIDGE REHABILITATION & SENIOR LIVING OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BESSEMER SUPER HWY
BESSEMER AL
35020-2412
US

IV. Provider business mailing address

4201 BESSEMER SUPER HWY
BESSEMER AL
35020-2412
US

V. Phone/Fax

Practice location:
  • Phone: 205-428-3249
  • Fax:
Mailing address:
  • Phone: 423-883-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAIM N HERTZEL
Title or Position: MANAGER
Credential:
Phone: 901-930-6124