Organization
MAGNOLIA MANOR INCORPORATED
Active
Parent organization
MAGNOLIA MANOR INCORPORATED
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAGNOLIA MANOR INCORPORATED
Authorized official
JERRY VICK (VP FINANCE)
(229) 924-9352
Entity
Organization
Contact information
Practice address
2001 S LEE ST, AMERICUS, GA 31709-4715
(229) 924-9352
Mailing address
2001 S LEE ST, AMERICUS, GA 31709-4715
(229) 924-9352
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040785C
—
GA
Enumeration date
06/27/2007
Last updated
03/12/2009
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