| Organization Name: | 718 MAGNOLIA, LLC |
| NPI Number: | 1518380948 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANK SAVINO (MANAGER) |
| Mailing Address: | 718 Magnolia Dr Lake Park |
| State: | FL US |
| Postal Code: | 334032009 |
| Phone Number: | 9083270003 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2014 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |