Provider Demographics
NPI:1275357725
Name:MAGNOLIA 9 LLC
Entity type:Organization
Organization Name:MAGNOLIA 9 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-250-8989
Mailing Address - Street 1:151 KALMUS DR STE A203
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5999
Mailing Address - Country:US
Mailing Address - Phone:402-250-8989
Mailing Address - Fax:714-475-2746
Practice Address - Street 1:14550 MAGNOLIA ST STE 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5586
Practice Address - Country:US
Practice Address - Phone:402-250-8989
Practice Address - Fax:714-475-2746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA 9 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)