Basic Information
| Provider Information | |||||||||
| NPI: | 1215109566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGNIFIED HEALTH & REHAB OF ANDERSON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778404465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9796931515 | ||||||||
| FaxNumber: | 9796960462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778404465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9796931515 | ||||||||
| FaxNumber: | 9796960462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9019377994 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DESCENDING DOVE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001016039 | 05 | TX | MEDICAID |