Organization
MAGNOLIA RETIREMENT HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANUEL M DOMISIW (OWNER/ADMINISTRATOR)
(863) 382-2116
Entity
Organization
Contact information
Practice address
149 MAGNOLIA AVE, SEBRING, FL 33870-3613
(863) 382-2116
(863) 382-2117
Mailing address
149 MAGNOLIA AVE, SEBRING, FL 33870-3613
(863) 382-2116
(863) 382-2117
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL4947
FL
3104A0625X
Assisted Living Facility (Mental Illness)
AL4947
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140646900
—
FL
Enumeration date
03/22/2011
Last updated
03/22/2011
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