Magnolis Gardens, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FCL-042-002 Issued in NC

Legal business name

MAGNOLIS GARDENS, INC

Doing business as

Magnolia Gardens Senior Care

Practice address

829 Roanoke Ave
Roanoke Rapids, NC 27870-2717

Phone

(252) 308-1743

NPI assigned

Feb 28, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kim Simpson

Title

Ceo

Phone

(252) 535-5006

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Magnolia Gardens Senior Care Doing business as

Tax ID family

Magnolia Gardens of Warrenton2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Magnolia Gardens, Inc.

  dba Magnolia Gardens of Warrenton

  • Assisted Living Facility
  • Roanoke Rapids, NC
  • NPI 1043347685
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053448522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2042",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278701242",
            "telephone_number": "252-535-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 ROANOKE AVE",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278702717",
            "telephone_number": "252-308-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIS GARDENS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-535-5006",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-042-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802782",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Gardens Senior Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sharon Faye Lynch-Jones, FNP-C
• M&T Counseling Services PLLC
• Holly Virginia Mackenna, M.D.
• Marco Pestanas Magno, PT
• Magnolia Gardens, Inc. (Magnolia Gardens of Warrenton)
• Curtis Mallory
• Ravinder Mamedi, M.D.
• Vijayalakshmi Mamedi, M.D.
• Natarajan Manickam, MD
• Nikta Mansouri

• Assisted Living Facility in Roanoke Rapids, NC
• Providers in Roanoke Rapids, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.