Provider Demographics
NPI:1861172512
Name:MAGNOLIA RESIDENTIAL CARE
Entity type:Organization
Organization Name:MAGNOLIA RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-912-9930
Mailing Address - Street 1:3813 MAVERICK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5126
Mailing Address - Country:US
Mailing Address - Phone:702-912-9930
Mailing Address - Fax:725-205-4501
Practice Address - Street 1:3813 MAVERICK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5126
Practice Address - Country:US
Practice Address - Phone:702-912-9930
Practice Address - Fax:725-205-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility