Provider Demographics
NPI:1093725871
Name:MAGNOLIA'S HOME CARE, LLC
Entity Type:Organization
Organization Name:MAGNOLIA'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
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:P O BOX 2547
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70502-2547
Mailing Address - Country:US
Mailing Address - Phone:337-232-4351
Mailing Address - Fax:337-232-4352
Practice Address - Street 1:1909 W. UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2545
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:2006-08-08
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12300251E00000X, 372600000X
LA12278376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334154Medicaid
LA1720879Medicaid