Provider Demographics
NPI:1487335857
Name:MAGNOLIA MEADOWS LLC
Entity type:Organization
Organization Name:MAGNOLIA MEADOWS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-618-2243
Mailing Address - Street 1:1750 HALLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3718
Mailing Address - Country:US
Mailing Address - Phone:941-391-7261
Mailing Address - Fax:
Practice Address - Street 1:1750 HALLS CREEK RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3718
Practice Address - Country:US
Practice Address - Phone:941-391-7261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility