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Organization
MAGNANIMOUS GROUP HOME LLC
Active
Organization
MAGNANIMOUS GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAIAH JOHNSON (CEO)
(910) 382-9985
Entity
Organization
Contact information
Practice address
9407 HWY 41 W, PINK HILL, NC 28572-7021
(910) 324-3276
Mailing address
9407 HWY 41 W, PINK HILL, NC 28572-7021
(910) 324-3276
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-052-016
NC
385H00000X
Respite Care
—
—
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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