Magnolia Court Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11993 Issued in FL

Legal business name

MAGNOLIA COURT ASSISTED LIVING

Practice address

103 Yacht Haven Dr
Cocoa Beach, FL 32931-2627

Phone

(321) 613-3029

NPI assigned

Jun 24, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Tracey Brinn Harrison

Title

Administrator

Phone

(321) 613-3029

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372032000000",
    "number": "1598104507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 YACHT HAVEN DR",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329312627",
            "telephone_number": "321-613-3029",
            "fax_number": "321-613-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 YACHT HAVEN DR",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329312627",
            "telephone_number": "321-613-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA COURT ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2013-06-24",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "BRINN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-613-3029",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Barlow St Clair Lynch, MD
• Jane Clemons Lyons, LCSW
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• Martha Fay LCSW Beachside Mental Health Counseling Services LLC
• Nazish Masoodi, MD

• Assisted Living Facility in Cocoa Beach, FL
• Providers in Cocoa 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 Jun 24, 2013; 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.