Provider Demographics
NPI:1104648930
Name:MAGNOLIA BEHAVIOR HEALTH CENTER LLC
Entity type:Organization
Organization Name:MAGNOLIA BEHAVIOR HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRIMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-473-0954
Mailing Address - Street 1:604 SOLAREX CT UNIT 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8655
Mailing Address - Country:US
Mailing Address - Phone:301-473-0954
Mailing Address - Fax:
Practice Address - Street 1:604 SOLAREX CT UNIT 205
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8655
Practice Address - Country:US
Practice Address - Phone:301-473-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347D00000XTransportation ServicesTrain