Organization
MAGNOLIA WOODS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER JAYNE WHITE (PRESIDENT/DIRECTOR)
(804) 550-8674
Entity
Organization
Contact information
Practice address
6688 TATUM RD, DISPUTANTA, VA 23842-6902
(804) 550-8674
Mailing address
6688 TATUM RD, DISPUTANTA, VA 23842-6902
(804) 550-8674
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/13/2013
Last updated
02/13/2013
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