Healthcare Provider Details

I. General information

NPI: 1376896258
Provider Name (Legal Business Name): MAGNOLIA HEALTH SYSTEMS 41, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 TECHNOLOGY DR
CARMEL IN
46032-5600
US

IV. Provider business mailing address

8455 KEYSTONE XING
INDIANAPOLIS IN
46240-4353
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-1786
  • Fax:
Mailing address:
  • Phone: 317-818-1240
  • Fax: 317-818-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number120003091
License Number StateIN

VIII. Authorized Official

Name: STUART B REED
Title or Position: PRESIDENT
Credential:
Phone: 317-818-1240