NPI | 1720798804 |
---|---|
Doing Business As | COUNTRY LIVING: MAGNOLIA HOUSE |
Entity Type | Organization |
Authorized Contact | KELLIE MICHELLE HARDISON Administrator 252-975-3741 |
Organization Subpart ? | Yes |
Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
Additional Taxonomies | 251S00000X |
311ZA0620X Custodial Care Facility, Adult Care Home | |
343900000X Non-emergency Medical Transport (VAN) | |
Enumeration Date | 2022-11-30 |
Last Update Date | 2023-01-26 |