Provider Demographics
NPI:1790159358
Name:MAGNOLIA HOSPICE, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOSPICE, LLC
Other - Org Name:SPRING VALLEY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-558-4122
Mailing Address - Street 1:2200 S BOWMAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4136
Mailing Address - Country:US
Mailing Address - Phone:501-558-4100
Mailing Address - Fax:501-296-9978
Practice Address - Street 1:1018 N GLOSTER ST STE J
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1234
Practice Address - Country:US
Practice Address - Phone:662-890-5554
Practice Address - Fax:662-890-5746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE HOME CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based