# MAGNOLIA BRIDGE LLC

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

## Provider details

- **NPI number:** 1649021114
- **Authorized official:** JASMINE MARIE FISHER (MANAGER)
- **Authorized official phone:** (727) 225-4305

## Contact information

- **Practice address:** 1567 HUNTINGTON LN, CLEARWATER, FL 33755-1338
- **Practice address phone:** (727) 225-4305
- **Mailing address:** 1345 SANDY LN, CLEARWATER, FL 33755-2042
- **Mailing address phone:** (727) 225-4305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 04/01/2024
- **Last updated:** 04/01/2024