MEDICARE: MAGNOLIA NURSING CENTER LLC

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	404	MS

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	:	1366426082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA NURSING CENTER LLC

Provider Business Mailing Address
First Line	:	3701 PETER QUINN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-3309
Country	:	US
Telephone Number	:	601-366-1712
Fax Number	:	601-366-1715

Provider Business Practice Location Address
First Line	:	3701 PETER QUINN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-3309
Country	:	US
Telephone Number	:	601-366-1712
Fax Number	:	601-366-1715

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MRS. TINA L ELLIS
Credential	:
Telephone Number	:	601-304-0980

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1427240779 — MAGNOLIA SENIOR CARE LLC
Practice Location Address:

3701 PETER QUINN DR
JACKSON, MS
39213-3309

Practice Phone: 601-366-1712
Practice Fax: 601-366-1715

1124369939 — BRITTANY TOUCHET CRNA
Practice Location Address:

11781 LEE JACKSON MEMORIAL HWY , SUITE 350
FAIRFAX, VA
22033-3309

Practice Phone: 703-295-9360
Practice Fax: 703-295-9369

1598130171 — TYLER BERCH CRNA
Practice Location Address:

11781 LEE JACKSON MEMORIAL HWY , #550
FAIRFAX, VA
22033-3309

Practice Phone: 703-293-9590
Practice Fax:

1275483836 — HOME OF HEART LLC
Practice Location Address:

2734 UTAH ST
JACKSON, MS
39213-4642

Practice Phone: 601-609-2127
Practice Fax:

1184607210 — DR. SRINIVASAN VIJAYAKUMAR M.D.
Practice Location Address:

350 W WOODROW WILSON AVE , SUITE 16
JACKSON, MS
39213-7681

Practice Phone: 601-815-6886
Practice Fax:

1598749210 — HINDS COUNTY NURSING &REHABILITATION CENTER LLC
Practice Location Address:

3454 ALBERMARLE ROAD
JACKSON, MS
39213

Practice Phone: 601-362-5394
Practice Fax: 601-366-9276

Directions to “MAGNOLIA NURSING CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.