Organization
MAGNOLIA PERSONAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FERLESHA KELLY (PRESIDENT)
(601) 786-1303
Entity
Organization
Contact information
Practice address
69 BO STAMPLEY RD, FAYETTE, MS 39069-4879
(601) 786-1303
Mailing address
PO BOX 2352, FAYETTE, MS 39069-2352
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
02/24/2020
Last updated
03/05/2020
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