Magnolia Nursing Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

404 Issued in MS

Legal business name

MAGNOLIA NURSING CENTER LLC

Practice address

3701 Peter Quinn Dr
Jackson, MS 39213-3309

Phone

(601) 366-1712

Fax

(601) 366-1715

NPI assigned

Dec 6, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Tina L Ellis

Title

Comptroller

Phone

(601) 304-0980

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366426082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 PETER QUINN DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392133309",
            "telephone_number": "601-366-1712",
            "fax_number": "601-366-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 PETER QUINN DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392133309",
            "telephone_number": "601-366-1712",
            "fax_number": "601-366-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "601-304-0980",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230160",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Magnolia Senior Care LLC
• Magnolia Sitters, LLC
• Magnolia Speech School
• Magnolia Woman'S Clinic, P.a.

• Skilled Nursing Facility in Jackson, MS
• Providers in Jackson, MS by specialty
• Skilled Nursing Facility in Mississippi

• 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.