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General NPI Number Information
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NPI Number | 1538204094
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MANOR AT TUPELO
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5427A FAIN LN
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City | BELDEN
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State | MS
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Zip | 38826-9214
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Country | US
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Telephone | 662-397-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 5427A FAIN LN
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City | BELDEN
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State | MS
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Zip | 38826-9214
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Country | US
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Telephone | 662-397-2733
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Fax |
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Authorized Official
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Title or Position | DIRECTOR ADMINISTRATIVE SERVICES
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Name | MRS. DEBRA D HAYNES
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Credential |
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Telephone | 662-842-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 1000
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License Number State | MS
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