Organization
MAGNOLIA NURSING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA L ELLIS (COMPTROLLER)
(601) 304-0980
Entity
Organization
Contact information
Practice address
3701 PETER QUINN DR, JACKSON, MS 39213-3309
(601) 366-1712
(601) 366-1715
Mailing address
3701 PETER QUINN DR, JACKSON, MS 39213-3309
(601) 366-1712
(601) 366-1715
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
404
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230160
—
MS
Enumeration date
12/06/2005
Last updated
08/22/2020
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