Magnolia Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MAGNOLIA ASSISTED LIVING, LLC

Practice address

152 South St
Calais, ME 04619-1324

Phone

(214) 557-1074

Fax

(214) 594-7127

NPI assigned

Jun 9, 2022

Last updated

Jun 9, 2022By 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

Edward Sedacca, JD

Title

President/Ceo

Phone

(214) 557-1074

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary E Dudzik, MD

  • Family Medicine Physician
  • Brewer, ME
  • NPI 1598735722
  NPD (past)
• Michael Oneal

  • Acute Care Nurse Practitioner
  • Ellsworth, ME
  • NPI 1386399830
  NPD (past)

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1407585912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5012 BRIDGE CREEK DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935702",
            "telephone_number": "214-557-1074",
            "fax_number": "214-594-7127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 SOUTH ST",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046191324",
            "telephone_number": "214-557-1074",
            "fax_number": "214-594-7127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "SEDACCA",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "214-557-1074",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared Lowe
• Nathaniel W Lutz, LCPC, NCC
• Brandi A Lyons
• Robert A Macmannis, OD
• Sally C. Madsen, RN
• Kevin J Makarowski
• Vicki D. Mason, OQMHP-C-PNMI
• Katherine E Matthews, MS, OTRL
• Dari-Lee McConnell, MHRT-C
• Melissa Diana McKenzie, CPNP

• Assisted Living Facility in Calais, ME
• Providers in Calais, ME by specialty
• Assisted Living Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.