Organization
MAGNOLIA GARDENS ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH STEVERSON (LPN/VICE PRESIDENT)
(601) 477-9041
Entity
Organization
Contact information
Practice address
303 EAST IVY, ELLISVILLE, MS 39437
(601) 477-9041
(601) 477-9006
Mailing address
303 E IVY ST, ELLISVILLE, MS 39437-2746
(601) 477-9041
(601) 477-9006
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
1059
MS
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
1059
MS
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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