Magnolia Gardens Assisted Living

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

1059 Issued in MS

Legal business name

MAGNOLIA GARDENS ASSISTED LIVING

Practice address

303 East Ivy
Ellisville, MS 39437

Phone

(601) 477-9041

Fax

(601) 477-9006

NPI assigned

Apr 10, 2017

Organization subpart

No

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

Authorized official

Name

Deborah Steverson

Title

LPN/Vice President

Phone

(601) 477-9041

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Magnolia Gardens Assisted Living

  • Assisted Living Facility (Behavioral Disturbances)
  • Laurel, MS
  • NPI 1336331685
  NPD tax ID
• Magnolia Gardens Assisted Living, Inc

  • Assisted Living Facility
  • Laurel, MS
  • NPI 1316217367
  NPD tax ID
• Magnolia Gardens Assisted Living, Inc

  • Assisted Living Facility
  • Laurel, MS
  • NPI 1780966424
  NPD tax ID

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1891228581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E IVY ST",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394372746",
            "telephone_number": "601-477-9041",
            "fax_number": "601-477-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 EAST IVY",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-477-9041",
            "fax_number": "601-477-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA GARDENS ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "STEVERSON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "LPN/VICE PRESIDENT",
        "authorized_official_telephone_number": "601-477-9041"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "1059",
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "MS",
            "license": "1059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe King
• Leighanne Kittrell
• Knox Academy, LLC
• Lloyd B. Wolfe, Jr., D.M.D.
• Debra Long, LPC
• Jammie Marques
• Pamela McAndrews, IDD WAIVER SERVICES
• Katherine N McCardle
• Kathleen Frances McCoy, P.T.
• Audrey McCullum, CCSS

• Assisted Living Facility (Behavioral Disturbances) in Ellisville, MS
• Providers in Ellisville, MS by specialty
• Assisted Living Facility (Behavioral Disturbances) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.