MAGNOLIA HEALTH SYSTEMS 49 LLC NPI 1730552811

NPI Information

NPI: 1730552811
Provider Name: MAGNOLIA HEALTH SYSTEMS 49, LLC

Doing Business As: BRECKENRIDGE COMMONS RESIDENTIAL FACILITY

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 15D2071122

Address:
2009 N HOSPITAL BLVD
SULLIVAN, IN
ZIP 47882
Phone: (812) 268-2000
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MAGNOLIA HEALTH SYSTEMS 49, LLC is an assisted living facility in Sullivan, IN. The provider is 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. MAGNOLIA HEALTH SYSTEMS 49, LLC NPI is 1730552811. The provider is registered as an organization entity type.
The provider Is Doing Business As Breckenridge Commons Residential Facility.

The provider's business location address is:

2009 N HOSPITAL BLVD
SULLIVAN, IN
ZIP 47882-658
Phone: (812) 268-2000
Fax: (812) 268-2080

The provider's authorized official is Stuart Reed .
The authorized official title is Member and has the following contact phone number (317) 818-1240.

The CLIA number assigned to this NPI record is 15D2071122 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2015 and was last updated on 11/11/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		15-013401-1	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	15-013401-1	OTHER	INDIANA	INDIANA STATE DEPARTMENT OF HEALTH LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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