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General NPI Number Information
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NPI Number | 1700214400
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MANOR SENIOR DAY PROGRAM, LLC
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 141 BARKS DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6774
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Country | US
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Telephone | 850-225-2985
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Fax |
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Provider Business Mailing Address
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Address Line | 141 BARKS DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6774
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Country | US
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Telephone | 850-225-2985
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. SARA A. O'NEAL
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Credential | CNA
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Telephone | 850-362-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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