# MAGNANIMOUS GROUP HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003047069
- **Authorized official:** ISAIAH JOHNSON (CEO)
- **Authorized official phone:** (910) 382-9985

## Contact information

- **Practice address:** 9407 HWY 41 W, PINK HILL, NC 28572-7021
- **Practice address phone:** (910) 324-3276
- **Mailing address:** 9407 HWY 41 W, PINK HILL, NC 28572-7021
- **Mailing address phone:** (910) 324-3276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | — | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-052-016 | NC | Yes |
| 385H00000X | Respite Care | — | — | — |

## Other

- **Enumeration date:** 08/06/2009
- **Last updated:** 08/06/2009