Organization
MAGNOLIA HOUSE L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON DIRK GODDARD (AR MANAGER)
(601) 824-9010
Entity
Organization
Contact information
Practice address
311 HIGHLAND BLVD, NATCHEZ, MS 39120-4635
(601) 446-5097
(601) 442-5930
Mailing address
106A OFFICE PARK DR, BRANDON, MS 39042-2404
(601) 824-9010
(601) 824-9044
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
672
MS
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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