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1730040585 NPI number — MAGNOLIA HOUSE RESIDENTIAL GROUP HOME FOR CHILDREN AND ADOLESCENTS, LLC

NPI Number: 1730040585
Health Care Provider/Practitioner: MAGNOLIA HOUSE RESIDENTIAL GROUP HOME FOR CHILDREN AND ADOLESCENTS, LLC

Information about “1730040585” NPI (MAGNOLIA HOUSE RESIDENTIAL GROUP HOME FOR CHILDREN AND ADOLESCENTS, LLC) exists in 1730040585 in HTML format HTML  |  1730040585 in plain Text format TXT  |  1730040585 in PDF (Portable Document Format) PDF  |  1730040585 in an XML format XML  formats.

NPI Number : 1730040585 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730040585",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MAGNOLIA HOUSE RESIDENTIAL GROUP HOME FOR CHILDREN AND ADOLESCENTS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10100 SUMMIT RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESTERFIELD",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23838-2327",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-393-6400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10100 SUMMIT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESTERFIELD",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23838-2327",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-393-6400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/20/2025",
    "LastUpdateDate": "11/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HIXSON",
    "AuthorizedOfficialFirstName": "MICHELLE",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "RN, OWNER, PROGRAM DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "804-393-6400",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320600000X",
        "TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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