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General NPI Number Information
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NPI Number | 1538292743
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Entity Type | Organization
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Legal Business Name | THE BLUE MAGNOLIA, LLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 829 N JUSTICE ST
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-3440
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Country | US
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Telephone | 828-899-0232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2102
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City | HENDERSONVILLE
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State | NC
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Zip | 28793-2102
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Country | US
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Telephone | 828-899-0232
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BERNARD FREDERIC
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Credential |
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Telephone | 828-899-0232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 3409557
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3409557
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 3409557
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 3408539
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License Number State | NC
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