Provider Demographics
NPI:1407585912
Name:MAGNOLIA ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:MAGNOLIA ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDACCA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:214-557-1074
Mailing Address - Street 1:5012 BRIDGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5702
Mailing Address - Country:US
Mailing Address - Phone:214-557-1074
Mailing Address - Fax:214-594-7127
Practice Address - Street 1:152 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1324
Practice Address - Country:US
Practice Address - Phone:214-557-1074
Practice Address - Fax:214-594-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility