MEDICARE: MAGDALENE HOUSE MINISTRIES 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	251S00000X	Community/Behavioral Health Agency

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	:	1497233860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGDALENE HOUSE MINISTRIES INC.

Provider Business Mailing Address
First Line	:	609 WOODRUFF PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4549
Country	:	US
Telephone Number	:	910-594-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 WOODRUFF PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-4549
Country	:	US
Telephone Number	:	910-594-4860
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JESSIKA MORGAN
Credential	:	CPSS, BA
Telephone Number	:	910-594-4860

Provider Enumeration Date	:	07/29/2018
Last Update Date	:	09/02/2020

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