Provider Demographics
NPI:1528879152
Name:MAGNOLIA ADULT DAY HABILITATION LLC
Entity type:Organization
Organization Name:MAGNOLIA ADULT DAY HABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVLONITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-838-6655
Mailing Address - Street 1:316 E GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1737
Mailing Address - Country:US
Mailing Address - Phone:201-838-6655
Mailing Address - Fax:201-903-4646
Practice Address - Street 1:2300 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4016
Practice Address - Country:US
Practice Address - Phone:201-838-6655
Practice Address - Fax:201-903-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services