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General NPI Number Information
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NPI Number | 1487564977
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEADOWS LLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 2000 GREENWAY ST
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City | KINGSPORT
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State | TN
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Zip | 37660-3020
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Country | US
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Telephone | 111-111-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 GREENWAY ST
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City | KINGSPORT
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State | TN
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Zip | 37660-3020
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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 | CEO
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Name | TRACY MARIE ROGERS
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Credential | LMHC, LPC
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Telephone | 941-391-7261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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