Provider Demographics
NPI:1437315561
Name:MAGNOLIA CENTER
Entity Type:Organization
Organization Name:MAGNOLIA CENTER
Other - Org Name:MAGNOLIA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:225-273-7274
Mailing Address - Street 1:16950 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-3803
Mailing Address - Country:US
Mailing Address - Phone:225-273-7274
Mailing Address - Fax:225-273-7284
Practice Address - Street 1:16950 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70819-3803
Practice Address - Country:US
Practice Address - Phone:225-273-7274
Practice Address - Fax:225-073-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00881103313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00881103OtherNURSING CARE FACILITIES