Magnolia Retirement Home Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL4947 Issued in FL

Legal business name

MAGNOLIA RETIREMENT HOME INC

Practice address

149 Magnolia Ave
Sebring, FL 33870-3613

Phone

(863) 382-2116

Fax

(863) 382-2117

NPI assigned

Mar 22, 2011

Last updated

Mar 22, 2011By 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

Mr. Manuel M Domisiw

Title

Owner/Administrator

Phone

(863) 382-2116

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1922307586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 MAGNOLIA AVE",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338703613",
            "telephone_number": "863-382-2116",
            "fax_number": "863-382-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 MAGNOLIA AVE",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338703613",
            "telephone_number": "863-382-2116",
            "fax_number": "863-382-2117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA RETIREMENT HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "DOMISIW",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "863-382-2116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL4947",
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL4947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140646900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janette Macasieb
• Mark Aris Macasieb, RPT
• Amanda Machin
• Mark Bruce Macneill, PHARMD
• Merci Grace Madar, MD
• Kyle Mallory, PHARMD
• Paul Milton Manrique, BCBA
• Jozabed Omri Maranan
• Maranatha Manor Inc.
• Bayani O Marasigan Jr., APRN

• Assisted Living Facility in Sebring, FL
• Providers in Sebring, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.