NPIMap

Organization Active NPI

Magnolia Gardens Assisted Living, Inc

  • Assisted Living Facility
  • Laurel, MS
National Provider Identifier
1780966424
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
1059 Issued in MS
Legal business name
MAGNOLIA GARDENS ASSISTED LIVING, INC
Practice address
945 West Dr
Laurel, MS 39440-4703
Phone
(601) 477-9041
NPI assigned
Sep 19, 2011
Last updated
Dec 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Mrs. Deborah Darlene Steverson, LPN
Title
Owner/Director
Phone
(601) 477-9041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 1059 MS Primary

Addresses

Primary practice location

945 West Dr
Laurel, MS 39440-4703

Mailing address

945 West Dr
Laurel, MS 39440-4703
Phone (601) 477-9041

Other identifiers 1

IdentifierTypeStateIssuer
00585888MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Gardens Assisted Living4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1780966424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 WEST DR",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404703",
            "telephone_number": "601-477-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 WEST DR",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404703",
            "telephone_number": "601-477-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA GARDENS ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-19",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "STEVERSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "601-477-9041",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "1059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00585888",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.