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MAGNOLIA NA LLC NPI 1245598390


NPI Information

NPI: 1245598390
Provider Name: MAGNOLIA NA, LLC

Other Name: MAGNOLIA PLACE OF NEW ALBANY

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 25D2193965

Address:
117 N BROADWAY ST
TUPELO, MS
ZIP 38804
Phone: (662) 840-3111
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MAGNOLIA NA, LLC is an assisted living facility in Tupelo, MS. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. MAGNOLIA NA, LLC NPI is 1245598390. The provider is registered as an organization entity type.
The provider Other Name Is Magnolia Place Of New Albany.

The provider's business location address is:

117 N BROADWAY ST
TUPELO, MS
ZIP 38804-901
Phone: (662) 840-3111
Fax: (662) 840-3119

The provider's authorized official is Art Shannon .
The authorized official title is Chief Operating Officer and has the following contact phone number 16628913054.

The CLIA number assigned to this NPI record is 25D2193965 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/26/2012 and was last updated on 4/26/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1310400000XAssisted Living Facility848MISSISSIPPIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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