Provider Demographics
NPI:1659736460
Name:MAGNOLIA HOSPICE OF THE DELTA, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOSPICE OF THE DELTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-540-0727
Mailing Address - Street 1:12120 COLONEL GLENN RD
Mailing Address - Street 2:SUITE 10,000
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2824
Mailing Address - Country:US
Mailing Address - Phone:870-540-0727
Mailing Address - Fax:
Practice Address - Street 1:12120 COLONEL GLENN RD
Practice Address - Street 2:SUITE 10,000
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2824
Practice Address - Country:US
Practice Address - Phone:870-540-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based