Magnolia Guest Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

079200401 Issued in CA

Legal business name

MAGNOLIA GUEST HOME LLC

Practice address

1639 Fairwood Dr
Concord, CA 94521

Phone

(925) 642-0427

NPI assigned

May 5, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Gene Lobaton Gepulle Jr.

Title

Administrator

Phone

(925) 642-0427

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568332800000",
    "number": "1245617620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292 ROYCE WAY",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945654700",
            "telephone_number": "925-427-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 FAIRWOOD DR",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "94521",
            "telephone_number": "925-642-0427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3006 Woodlawn Dr",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945972048",
            "country_code": "US",
            "telephone_number": "925-278-2927",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2448 Stanford Way",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "CA",
            "postal_code": "945318263",
            "country_code": "US",
            "telephone_number": "925-642-0427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA GUEST HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2019-09-13",
        "status": "A",
        "authorized_official_last_name": "GEPULLE",
        "authorized_official_first_name": "GENE",
        "authorized_official_middle_name": "LOBATON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "925-642-0427",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "079200401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalyani Maganti, M.D.
• Yestin Loveli Joaquin Magbanua
• Madison Hailey Maggy
• Cody Maglinti
• Bryant Magno
• Collette Magurno
• Ved Mahadevan
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• Nanu Maharjan Dangol
• Malaya Mahenderker

• Assisted Living Facility in Concord, CA
• Providers in Concord, 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 Sep 13, 2019; 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.