Magnolia Manor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

496801129 Issued in CA

Legal business name

MAGNOLIA MANOR

Practice address

387 Magnolia Dr
Healdsburg, CA 95448-9407

Phone

(707) 433-9705

Fax

(707) 473-0161

NPI assigned

Mar 23, 2016

Organization subpart

No

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

Authorized official

Name

Elizabeth Bebie Matos

Title

Administrator

Phone

(707) 217-3908

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1154783660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 MAGNOLIA DR",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954489407",
            "telephone_number": "707-433-9705",
            "fax_number": "707-473-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 MAGNOLIA DR",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954489407",
            "telephone_number": "707-433-9705",
            "fax_number": "707-473-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "MATOS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "BEBIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "707-217-3908"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "496801129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tess Marie Lusher, MD
• Pernille E Luzaich, LVN
• Walter C. Maack, M.D.
• Cameron Duane Macinnis, MD
• Diana Marie Madison, PA
• Nina Maisterra, MD
• Paul J Marguglio
• Gianna Marinai-Davy, MS SLP CCC
• Ronald James Marinelli, P.T.
• Damian Marsden, MD

• Assisted Living Facility in Healdsburg, CA
• Providers in Healdsburg, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.