Magnolia Manor Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12096 Issued in FL

Legal business name

MAGNOLIA MANOR ASSISTED LIVING, INC.

Practice address

17420 Old Tobacco Rd
Lutz, FL 33558-4979

Phone

(813) 918-0588

NPI assigned

Aug 8, 2012

Organization subpart

No

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

Authorized official

Name

Barbara Keithly

Title

President

Phone

(813) 918-0588

Specialties & licenses 1

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

Locations

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344384000000",
    "number": "1982951067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17420 OLD TOBACCO RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335584979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17420 OLD TOBACCO RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335584979",
            "telephone_number": "813-918-0588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MANOR ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A",
        "authorized_official_last_name": "KEITHLY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-918-0588"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ma, MD, LLC
• Racquel S Maccagno, ARNP
• Kimberly Macgregor
• Adrienne Maddox, M.S., CCC-SLP
• Abby Noreen Madlener
• Maya V Maharana, SLP
• Richa Mahatme, DDS
• Mahesh Bhambore MD PA
• Gabrielle Mai, APRN
• Phoebe Aimel Maisto, LMHC

• Assisted Living Facility in Lutz, FL
• Providers in Lutz, 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 Aug 8, 2012; 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.