Provider Demographics
NPI:1841185600
Name:MAGNOLIA MEDICAL SERVICES PC
Entity type:Organization
Organization Name:MAGNOLIA MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN-REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-621-0466
Mailing Address - Street 1:999 N NORTHLAKE WAY STE 214B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3422
Mailing Address - Country:US
Mailing Address - Phone:855-621-0466
Mailing Address - Fax:888-471-4927
Practice Address - Street 1:16922 AIRPORT BLVD RM 30
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1655
Practice Address - Country:US
Practice Address - Phone:855-621-0466
Practice Address - Fax:888-471-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty