Organization
MAGNOLIAS WAY LLC
Active
Other names
Magnolias Way LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER V DACCHILLE CEO (CEO)
(786) 308-1676
Entity
Organization
Contact information
Practice address
1020 E COLLEGE ST, PULASKI, TN 38478-4547
(786) 308-1676
Mailing address
1020 E COLLEGE ST, PULASKI, TN 38478-4547
(786) 308-1676
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L000000028393
STATE LICENSE
TN
Enumeration date
06/17/2021
Last updated
06/17/2021
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