Organization
MAGNOLIA BRIDGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE MARIE FISHER (MANAGER)
(727) 225-4305
Entity
Organization
Contact information
Practice address
1567 HUNTINGTON LN, CLEARWATER, FL 33755-1338
(727) 225-4305
Mailing address
1345 SANDY LN, CLEARWATER, FL 33755-2042
(727) 225-4305
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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