Magnolia Bridge LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

MAGNOLIA BRIDGE LLC

Practice address

1567 Huntington LN
Clearwater, FL 33755-1338

Phone

(727) 225-4305

NPI assigned

Apr 1, 2024

Organization subpart

No

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

Authorized official

Name

Jasmine Marie Fisher

Title

Manager

Phone

(727) 225-4305

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1649021114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 SANDY LN",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337552042",
            "telephone_number": "727-225-4305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1567 HUNTINGTON LN",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337551338",
            "telephone_number": "727-225-4305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA BRIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "JASMINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-225-4305"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Maddox
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• Brittany Christina Maglio, ARNP
• Magnano Health Center LLC.
• Magnolia Manor, Inc.
• Tracy Mahany
• Jenen Mahdi
• Mahesh Amin PA
• Jazbeen Mahmood, M.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.