Organization
THE BLUE MAGNOLIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD FREDERIC (MANAGER)
(828) 899-0232
Entity
Organization
Contact information
Practice address
829 N JUSTICE ST, HENDERSONVILLE, NC 28791-3440
(828) 899-0232
Mailing address
PO BOX 2102, HENDERSONVILLE, NC 28793-2102
(828) 899-0232
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
3409557
NC
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
3408539
NC
253Z00000X
In Home Supportive Care Agency
3409557
NC
385H00000X
Respite Care
3409557
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408539
—
NC
Enumeration date
03/14/2007
Last updated
06/18/2013
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