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General NPI Number Information
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NPI Number | 1184344061
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Entity Type | Organization
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Legal Business Name | MAGNOLIA SOUTHERN CARE LLC
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 10151 DEERWOOD PARK BLVD STE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0566
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Country | US
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Telephone | 904-577-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 10151 DEERWOOD PARK BLVD STE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0566
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Country | US
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Telephone | 904-577-2440
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | JESSICA MICHELLE MCCREE BRADDY
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Credential | MPA,BHCA,CCMA,CNA
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Telephone | 904-577-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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