Healthcare Provider Details

I. General information

NPI: 1538094354
Provider Name (Legal Business Name): MAGNOLIA'S SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 DIXON RD
ELGIN SC
29045-9030
US

IV. Provider business mailing address

217 E FAIR HAVEN LN
LYMAN SC
29365-9272
US

V. Phone/Fax

Practice location:
  • Phone: 864-529-5567
  • Fax:
Mailing address:
  • Phone: 864-529-5567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHANELLE ALLEN
Title or Position: ADMINISTRATOR
Credential: RN BSN
Phone: 864-529-5567