Provider Demographics
NPI:1043395544
Name:MAGNOLIA'S PERSONAL CARE MEDICAL DURABLE EQUIPMENT INC
Entity Type:Organization
Organization Name:MAGNOLIA'S PERSONAL CARE MEDICAL DURABLE EQUIPMENT INC
Other - Org Name:MAGNOLIA'S HOME CARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-232-4351
Mailing Address - Street 1:920 WEST PINHOOK ROAD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-232-4351
Mailing Address - Fax:337-232-4352
Practice Address - Street 1:205 CROUCHET ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-232-4351
Practice Address - Fax:337-232-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12278332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623709Medicaid
LA1720879Medicaid