Organization Name: | MAGNOLIA MANOR |
NPI Number: | 1154783660 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ELIZABETH BEBIE MATOS (ADMINISTRATOR) |
Mailing Address: | 387 Magnolia Dr Healdsburg |
State: | CA US |
Postal Code: | 954489407 |
Phone Number: | 7074339705 |
Fax Number: | 7074730161 |
NPI Enumeration Date: | 03/23/2016 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 496801129 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |