Organization
MAGNOLIA MANOR AT TUPELO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA D HAYNES (DIRECTOR ADMINISTRATIVE SERVICES)
(662) 842-6776
Entity
Organization
Contact information
Practice address
5427A FAIN LN, BELDEN, MS 38826-9214
(662) 397-2733
Mailing address
5427A FAIN LN, BELDEN, MS 38826-9214
(662) 397-2733
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1000
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03083202
—
MS
Enumeration date
02/21/2007
Last updated
08/22/2020
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