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General NPI Number Information
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NPI Number | 1326507260
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Entity Type | Organization
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Legal Business Name | ALPHA MAGNOLIA GARDEN LLC
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 930 HWY. 158 BUS. EAST
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City | WARRENTON
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State | NC
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Zip | 27589
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Country | US
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Telephone | 919-819-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 5842 FARINGDON PL STE 2
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City | RALEIGH
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State | NC
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Zip | 27609-3930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JULIET OKWOSHAH
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Credential |
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Telephone | 919-819-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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