MAGNOLIA MANOR
NPI 1164418554
Skilled Nursing Facility in Groves, TX
NPI Status: Active since September 21, 2005
Contact Information
4400 GULF AVE
GROVES, TX
ZIP 77619
Phone: (409) 962-5785
Fax: (409) 962-2944
- Organization
- Skilled Nursing Facility
- CLIA Number: 45D0968448
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 12-12-2027
About MAGNOLIA MANOR
This page provides the complete NPI Profile along with additional information for Magnolia Manor, a provider established in Groves, Texas operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1164418554 assigned on September 2005. The practitioner's primary taxonomy code is 314000000X with license number 114561 (TX). The provider is registered as an organization and their NPI record was last updated 18 years ago. The provider's is doing business as Magnolia Manor. The authorized official of this NPI record is Mrs. Robin Underhill (Chief Executive)
- NPI
- 1164418554
- Provider Legal Name
- CRESTHAVEN HEALTH CARE CENTER LTD CO
- Other Organization Name
- MAGNOLIA MANOR
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4400 GULF AVE GROVES, TX 77619
- Location Phone
- (409) 962-5785
- Location Fax
- (409) 962-2944
- Mailing Address
- 2537 GOLDEN BEAR DR CARROLLTON, TX 75006
- Mailing Phone
- (214) 954-4114
- Mailing Fax
- (409) 962-2944
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-21-2005
- Last Update Date
- 09-16-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Skilled Nursing Facility
- Taxonomy Code
- 314000000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 114561
- License State
- TX
- Taxonomy Description
- (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 332BP3500X | Suppliers | Durable Medical Equipment & Medical Supplies |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 022622701 | MEDICAID (05) | TX | |
| 455538 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | MEDICARE PROVIDER NUMBER |
| 000446604 | MEDICAID (05) | TX | |
| 1296450001 | MEDICARE NSC (07) | ||
| 021439701 | MEDICAID (05) | TX |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D0968448
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- December 13, 2025
- Certificate Expiration Date
- December 12, 2027
- Laboratory Director
- DELPHIA SMITH
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Magnolia Manor to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164418554, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164418554, enumerated as an "organization" on September 21, 2005.
The provider is located at 4400 GULF AVE GROVES, TX 77619 and the phone number is (409) 962-5785.
Skilled Nursing Facility with taxonomy code 314000000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
