MAGNOLIA GARDENS ASSISTED LIVING (NPI# 1891228581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891228581 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA GARDENS ASSISTED LIVING |
| Practice Address |
303 East Ivy Ellisville MS 39437 |
| Mailing Address |
303 E Ivy St Ellisville MS 39437-2746 |
| Practice Telephone | 6014779041 |
| Practice Fax Number | 6014779006 |
| Mailing Telephone | 6014779041 |
| Mailing Fax Number | 6014779006 |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |
| Authorized Official Name | DEBORAH STEVERSON (LPN/VICE PRESIDENT) |
| Authorized Official Telephone | 6014779041 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | 1059 | MS | Nursing & Custodial Care Facilities |
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
1059 | MS | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336331685 | Magnolia Gardens Assisted Living | Private Vehicle | 945 West Dr, Laurel, MS 39440-4703 | 2007-08-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MAGNOLIA GARDENS ASSISTED LIVING | 1425 Daugherty, Cottage Grove, OR 97424 |
| Oklahoma Business Registrations | MAGNOLIA GARDENS ASSISTED LIVING & MEMORY CARE, LLC | 3723 Fairview Industrial Dr Se Ste 270, Salem, OR 97302-0006 |
| Street Address |
303 EAST IVY |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
| 1972851814 | Dental Group of Ellisville, Pllc | Dentist | 97 Hal Crocker Road, Ellisville, MS 39437 | 2012-08-27 |
| 1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
| 1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
| 1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
| 1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
| 1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| 1316980097 | Donald Scoggin | Nurse Practitioner | 1203 Ave B, Ellisville, MS 39437 | 2006-06-13 |
| Find all providers in zip 39437 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669086591 | Justlikehome Supportive Living LLC | Assisted Living Facility | 9 County Road 3312, Enterprise, MS 39330-9070 | 2020-09-08 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1851661938 | Saint Francis Community Services In Mississippi Inc | Assisted Living Facility | 503 Seal St, Apt #7, Picayune, MS 39466-5386 | 2012-01-06 |
| City | ELLISVILLE |
| Zip Code | 39437 |
Please comment or provide details below to improve the information on MAGNOLIA GARDENS ASSISTED LIVING.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.