Organization
MAGNOLIA GARDENS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
6710 MALLERY DR, LANHAM, MD 20706-3964
(301) 552-2000
Mailing address
6710 MALLERY DR, LANHAM, MD 20706-3964
(301) 552-2000
(610) 612-5327
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
16011
MD
314000000X
Skilled Nursing Facility
Primary
16-011
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028F
CAREFIRST PROV/INQ#
—
01
—
0529622
AENTA-HMO
—
01
—
08952
AMERIGROUP
—
01
—
345178
UNITED - MAMSI
—
01
—
7100074
UNITED - AMERICHOICE
—
05
—
818989700
—
MD
01
—
HV1
CAREFIRST BLUECHOICE
—
Enumeration date
06/10/2006
Last updated
06/23/2025
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