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General NPI Number Information
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NPI Number | 1760677413
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Entity Type | Organization
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Legal Business Name | MAGNOLIA GARDENS
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 594 MURRAY HILL RD
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City | SOUTHERN PINES
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State | NC
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Zip | 28387
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Country | US
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Telephone | 910-692-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 594 MURRAY HILL RD
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7016
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Country | US
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Telephone | 910-692-6311
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH YARBROUGH
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Credential |
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Telephone | 336-983-7635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL-063-007
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License Number State | NC
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