Magnolia Ranch Recovery LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MAGNOLIA RANCH RECOVERY LLC

Practice address

111 Stripmine Rd
Pulaski, TN 38478-8182

Phone

(931) 425-6303

Fax

(866) 318-9108

NPI assigned

Apr 27, 2017

Organization subpart

No

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

Authorized official

Name

Peter Dacchille

Title

Ceo

Phone

(786) 308-1676

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keith Watts, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Madison, AL
  • NPI 1710432190
  NPD (past)

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1902331929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 E COLLEGE ST",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784547",
            "telephone_number": "931-425-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 STRIPMINE RD",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384788182",
            "telephone_number": "931-425-6303",
            "fax_number": "866-318-9108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 Stevens Hollow Rd",
            "address_purpose": "LOCATION",
            "city": "Taft",
            "state": "TN",
            "postal_code": "384885269",
            "country_code": "US",
            "telephone_number": "931-425-6303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 stripmine rd",
            "address_purpose": "LOCATION",
            "city": "pulaski",
            "state": "TN",
            "postal_code": "384788182",
            "country_code": "US",
            "telephone_number": "931-347-4966",
            "fax_number": "866-318-9108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA RANCH RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-27",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "DACCHILLE",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-308-1676"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Diane Lowry, DPT
• Todd Jefferson Lucas, MD
• Joshua James Lunn, DPT
• Eva Perez Maboloc
• Purushothaman Madhu, MD
• Magnolias Way LLC
• Valerie S. Manning, M.S. CCC-SLP
• Martin Methodist Clinic
• Lani Marie Martin, DPT
• Mashburn Family Health, PLLC

• Substance Abuse Rehabilitation Facility in Pulaski, TN
• Providers in Pulaski, TN by specialty
• Substance Abuse Rehabilitation Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.