Magnolia Lane LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

SCL026031 Issued in NC

Legal business name

MAGNOLIA LANE LLC

Practice address

3510 Camden Rd
Fayetteville, NC 28306-7717

Phone

(910) 425-8751

Fax

(910) 644-1257

NPI assigned

Jan 17, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Judy B Tew, OWNER

Title

Administrator

Phone

(910) 425-8751

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Forest Hill Group Home Former legal business name

Locations

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1740466937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 CAMDEN RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283067717",
            "telephone_number": "910-425-8751",
            "fax_number": "910-644-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 CAMDEN RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283067717",
            "telephone_number": "910-425-8751",
            "fax_number": "910-644-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA LANE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "TEW",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-425-8751",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "SCL026031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805591",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Hill Group Home",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mads DME 02207
• Chinwendu Nneka Madukwe, DO
• Jennifer Mafnas
• Magby Associates, Inc.
• Adrienne Magill
• Kelsi Eve Magnusson
• Allison Mahaffey
• Sejal Sonia Mahajan, DO
• Alexis Maharty, OT
• Donald Clinton Maharty, DO

• Assisted Living Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; 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.