Healthcare Provider Details

I. General information

NPI: 1659353134
Provider Name (Legal Business Name): MAGNOLIA MANOR OF MARION COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 GENEVA RD
BUENA VISTA GA
31803-1701
US

IV. Provider business mailing address

349 GENEVA RD
BUENA VISTA GA
31803-1701
US

V. Phone/Fax

Practice location:
  • Phone: 229-649-2331
  • Fax:
Mailing address:
  • Phone: 229-649-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10961816
License Number StateGA

VIII. Authorized Official

Name: MRS. BARBARA MITCHELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-649-2331