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General NPI Number Information
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NPI Number | 1336331685
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Entity Type | Organization
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Legal Business Name | MAGNOLIA GARDENS ASSISTED LIVING
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 945 WEST DR
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City | LAUREL
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State | MS
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Zip | 39440-4703
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Country | US
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Telephone | 601-649-6660
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Fax | 601-428-4685
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Provider Business Mailing Address
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Address Line | 945 WEST DR
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City | LAUREL
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State | MS
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Zip | 39440-4703
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Country | US
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Telephone | 601-649-6660
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Fax | 601-428-4685
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. DEBORAH DARLENE STEVERSON
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Credential | LPN
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Telephone | 601-649-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 898
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 898
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 898
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License Number State | MS
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