Provider Demographics
NPI:1215109566
Name:MAGNIFIED HEALTH & REHAB OF ANDERSON, LLC
Entity type:Organization
Organization Name:MAGNIFIED HEALTH & REHAB OF ANDERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:1115 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4465
Mailing Address - Country:US
Mailing Address - Phone:979-693-1515
Mailing Address - Fax:979-696-0462
Practice Address - Street 1:1115 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4465
Practice Address - Country:US
Practice Address - Phone:979-693-1515
Practice Address - Fax:979-696-0462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESCENDING DOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016039Medicaid
TX675366Medicare Oscar/Certification