Magnola Manor at Daytona Beach, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8869 Issued in FL

Legal business name

MAGNOLA MANOR AT DAYTONA BEACH, LLC

Practice address

252 Forest Lake Blvd
Daytona Beach, FL 32119-8106

Phone

(863) 226-0358

NPI assigned

Aug 29, 2016

Organization subpart

No

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

Authorized official

Name

Savitri Johnson

Title

Administrative Assistant

Phone

(863) 226-0358

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1134675234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 LAKE MORTON DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 FOREST LAKE BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321198106",
            "telephone_number": "863-226-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLA MANOR AT DAYTONA BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAVITRI",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "863-226-0358"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katarzyna I. Madejczyk, MD
• Shardae Madison, RBT
• Samantha Maffucci, OT
• Magenta BP LLC
• Marcus Magidow, APRN
• Hannah Neve Magnuson, APRN
• Elena Lucy Magrans, M.D., M.P.H.
• Dawn R Mahaffey, LCSW
• John Patrick Maher, DC, CCSP
• Ravinkumar Maheshkumar, DO

• Assisted Living Facility in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.