NPI 1003047069

Magnanimous Group Home LLC

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Pink Hill, NC

Practice location

Address: 9407 Hwy 41 W, Pink Hill, NC 28572-7021
Phone: (910) 324-3276

Authorised official

Name: Isaiah Johnson
Title: Ceo
Phone: (910) 382-9985

Registered specialties (3)

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence MHL-052-016 (NC)

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Case Management Agency

Agencies Taxonomy 251B00000X

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Respite Care

Respite Care Facility Taxonomy 385H00000X

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Registry record

NPI: 1003047069
Entity type: Organization
NPI issued: 6 Aug 2009
Record last updated: 6 Aug 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.