- Enrollment id
- O20070827000692
- Enrollment state
- MS
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427240779
- Multiple npi flag
- N
- Ccn
- 255275
- Associate id
- 3971695503
- Organization name
- MAGNOLIA SENIOR CARE LLC
- Incorporation date
- 2007-02-01
- Incorporation state
- MS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MAGNOLIA SENIOR CARE, LLC
- Address line 1
- 3701 PETER QUINN DR
- City
- JACKSON
- State
- MS
- Zip code
- 392133309