Provider Demographics
NPI:1316177595
Name:MAGNOLIA PERSONAL CARE HOME
Entity type:Organization
Organization Name:MAGNOLIA PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-798-4007
Mailing Address - Street 1:174 CLIFF MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7982
Mailing Address - Country:US
Mailing Address - Phone:601-798-4007
Mailing Address - Fax:
Practice Address - Street 1:174 CLIFF MITCHELL RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-7982
Practice Address - Country:US
Practice Address - Phone:601-798-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility