Magnolia Manor Senior Day Program, LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

MAGNOLIA MANOR SENIOR DAY PROGRAM, LLC

Practice address

141 Barks Dr
Fort Walton Beach, FL 32547-6774

Phone

(850) 225-2985

NPI assigned

Oct 16, 2013

Last updated

Oct 16, 2013By 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

Mrs. Sara A. O'Neal, CNA

Title

Owner/Administrator

Phone

(850) 362-6556

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1700214400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 BARKS DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476774",
            "telephone_number": "850-225-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 BARKS DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476774",
            "telephone_number": "850-225-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MANOR SENIOR DAY PROGRAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "O'NEAL",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "850-362-6556",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000706400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theodore I Macey, MD PA
• Christina Ann Macmanus, LCSW
• Shannon Macmaster
• Kelsey Elizabeth Maddry-Smith, RBT
• Venkata R Magisetty
• Magnolia Medical Clinic P.a.
• Magnolia Rehab Services (Magnolia Pediatric Therapy)
• Victoria Magnuson, PT, DPT
• Paula Magtanong
• Daanish Mahmood, DO

• Adult Day Care Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Adult Day Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.