Organization
MAGNOLIA MANOR ASSISTED LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA KEITHLY (PRESIDENT)
(813) 918-0588
Entity
Organization
Contact information
Practice address
17420 OLD TOBACCO RD, LUTZ, FL 33558-4979
(813) 918-0588
Mailing address
17420 OLD TOBACCO RD, LUTZ, FL 33558-4979
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12096
FL
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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