MAGNOLIA GUEST HOME LLC (NPI# 1245617620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245617620 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA GUEST HOME LLC |
| Practice Address |
1639 Fairwood Dr Concord CA 94521 |
| Mailing Address |
292 Royce Way Pittsburg CA 94565-4700 |
| Practice Telephone | 9256420427 |
| Mailing Telephone | 9254279070 |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2019-09-13 |
| Authorized Official Name | MR. GENE LOBATON GEPULLE JR. (ADMINISTRATOR) |
| Authorized Official Telephone | 9256420427 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 079200401 | CA | Nursing & Custodial Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3006 Woodlawn Dr, Walnut Creek, CA 945972048 | 9252782927 | |
| 2448 Stanford Way, Antioch, CA 945318263 | 9256420427 |
| Street Address |
1639 FAIRWOOD DR |
| City | CONCORD |
| State | CA |
| Zip Code | 94521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184169229 | Bronze Owl LLC | Non-emergency Medical Transport (VAN) | 1424 Cape Cod Way, Concord, CA 94521 | 2016-12-28 |
| 1326436387 | Yolanda Rosemarie Overton | Counselor | 2191 Kirker Pass Road, Concord, CA 94521 | 2014-12-29 |
| 1174872063 | Clayton Valley Charter High School | Local Education Agency (LEA) | 1101 Alberta Way, Concord, CA 94521 | 2012-09-06 |
| 1720365026 | Danielle Liane Allen | Occupational Therapist | 4367 Concord Blvd., Concord, CA 94521 | 2011-11-15 |
| 1003095951 | Bita Louise Matin | Dentist | 1494 Balhan Dr, Concord, CA 94521 | 2007-10-29 |
| 1265567333 | Nic Usa Inc | Intermediate Care Facility, Mentally Retarded | 4118 Phoenix St, Concord, CA 94521 | 2007-02-22 |
| 1780729392 | Nic Usa Inc | Intermediate Care Facility, Mentally Retarded | 4160 Phoenix St, Concord, CA 94521 | 2007-02-21 |
| 1528121118 | New Way Services Inc | Intermediate Care Facility, Mentally Retarded | 5166 Sutherland Dr, Concord, CA 94521 | 2006-12-18 |
| 1407918576 | Horace Joseph Beach | Psychologist | 1460 Washington Blvd Ste C-6, Concord, CA 94521 | 2006-12-15 |
| 1821164815 | Stephen Elliott Ludwig | Dentist | 1494 Washington Blvd Suite D, Concord, CA 94521 | 2006-11-28 |
| Find all providers in zip 94521 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891266011 | Letitia Trif | Assisted Living Facility | 3647 Wren Ave, Concord, CA 94519-1767 | 2018-12-16 |
| 1245746890 | A Blissful Retreat, LLC | Assisted Living Facility | 4200 Cowell Rd, Concord, CA 94518-1806 | 2017-12-19 |
| 1891149761 | Home Sweet Care Homes, Inc. | Assisted Living Facility | 1584 Dianda Dr, Concord, CA 94521-1951 | 2016-04-18 |
| 1942693049 | Agape Assisted Living Inc | Assisted Living Facility | 1841 Andrea Ln, Concord, CA 94519-1830 | 2015-03-12 |
| 1053718783 | Aj's Senior Care Home | Assisted Living Facility | 3938 Cowell Rd, Concord, CA 94518-1709 | 2014-11-24 |
| 1396160685 | Paradise Villa Senior Care, LLC | Assisted Living Facility | 836 San Simeon Dr, Concord, CA 94518-2245 | 2014-02-24 |
| 1265747562 | Concord Place | Assisted Living Facility | 2452 Rock Hill Church Rd Nw, Concord, NC 28027-8048 | 2010-08-11 |
| 1811141104 | Twenty Two Pack Management Corp | Assisted Living Facility | 1501 Zion Church Rd E, Concord, NC 28025-6827 | 2008-11-13 |
| 1841316635 | Volunteers of America-concord Park | Assisted Living Facility | 68 Commonwealth Ave, Concord, MA 01742-2967 | 2007-03-22 |
| 1245360940 | Villa Vittoria | Assisted Living Facility | 1191 Vista Ridge Ct, Concord, CA 94518-1739 | 2007-03-06 |
| Find all providers in CONCORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.