Provider Demographics
NPI:1093879041
Name:MAGNOLIA REGIONAL HEALTH CENTER - HOSPICE
Entity Type:Organization
Organization Name:MAGNOLIA REGIONAL HEALTH CENTER - HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOMECARE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LBSW, MPH, MBA
Authorized Official - Phone:662-293-1401
Mailing Address - Street 1:1001 S HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6646
Mailing Address - Country:US
Mailing Address - Phone:662-293-1405
Mailing Address - Fax:662-286-4242
Practice Address - Street 1:1001 S HARPER RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6646
Practice Address - Country:US
Practice Address - Phone:662-293-1405
Practice Address - Fax:662-286-4242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA REGIONAL HEALTH CENTER - HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000070660Medicaid
MS000070943OtherHOME CARE AGENCY
TN0000000386OtherTN STATE LICENSURE
MS000070943OtherHOME CARE AGENCY