MEDICARE: MAGNOLIA MANOR OF COLUMBUS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	240031	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164456133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA MANOR OF COLUMBUS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 9696
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31908-9696
Country	:	US
Telephone Number	:	706-324-0387
Fax Number	:	706-324-0927

Provider Business Practice Location Address
First Line	:	2000 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7932
Country	:	US
Telephone Number	:	706-324-0387
Fax Number	:	706-324-0927

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MRS. SIBYL P. BLEDSOE
Credential	:
Telephone Number	:	229-931-5904

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/06/2011

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