Healthcare Provider Details

I. General information

NPI: 1073443040
Provider Name (Legal Business Name): MAGNOLIAS RECOVERY AND TRANSITIONAL HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 RED OAK AVE
DURHAM NC
27707-4924
US

IV. Provider business mailing address

PO BOX 15392
DURHAM NC
27704-0392
US

V. Phone/Fax

Practice location:
  • Phone: 984-281-6116
  • Fax:
Mailing address:
  • Phone: 984-281-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. LACHRYSTAL WILLIAMS
Title or Position: OWNER
Credential:
Phone: 919-452-5356