Provider Demographics
NPI:1831335637
Name:MAGNOLIA HEALTH SYSTEM IX, INC.
Entity type:Organization
Organization Name:MAGNOLIA HEALTH SYSTEM IX, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:PAINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-244-2600
Mailing Address - Street 1:9455 DELEGATES ROW
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3805
Mailing Address - Country:US
Mailing Address - Phone:317-818-1240
Mailing Address - Fax:317-818-1430
Practice Address - Street 1:55 MISSION DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-5907
Practice Address - Country:US
Practice Address - Phone:317-244-2600
Practice Address - Fax:317-244-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN080118401310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility