Organization
MAGNOLIA PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN LANE MORRIS (ADMINISTRATOR)
(336) 751-2214
Entity
Organization
Contact information
Practice address
270 DUKE ST, MOCKSVILLE, NC 27028-2504
(336) 751-2214
Mailing address
270 DUKE ST, MOCKSVILLE, NC 27028-2504
(336) 751-2214
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
FCL-030-002
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FCL-030-002
—
NC
Enumeration date
02/27/2007
Last updated
08/22/2020
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