Provider Demographics
NPI:1558697912
Name:MAGNOLIA MEDICAL STAFFING, LLC
Entity Type:Organization
Organization Name:MAGNOLIA MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ELDRIDGE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRTT
Authorized Official - Phone:504-371-1149
Mailing Address - Street 1:2440 PAIGE JANETTE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-371-1149
Mailing Address - Fax:
Practice Address - Street 1:2440 PAIGE JANETTE DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2137
Practice Address - Country:US
Practice Address - Phone:504-371-1149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALT1454253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care