Organization
MAGNOLIA HOUSE PCH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA R WHITLEY RN (DIRECTOR)
(912) 384-3377
Entity
Organization
Contact information
Practice address
221 COLLEGE AVE S, DOUGLAS, GA 31533-2303
(912) 384-3377
Mailing address
221 COLLEGE AVE S, DOUGLAS, GA 31533-2303
(912) 384-3377
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/05/2007
Last updated
08/22/2020
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