Provider Demographics
NPI:1841431210
Name:THE MAGNOLIA SCHOOL, INC.
Entity Type:Organization
Organization Name:THE MAGNOLIA SCHOOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF SIL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MERIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-731-1371
Mailing Address - Street 1:100 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-3402
Mailing Address - Country:US
Mailing Address - Phone:504-731-1371
Mailing Address - Fax:504-731-1354
Practice Address - Street 1:100 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-3402
Practice Address - Country:US
Practice Address - Phone:504-731-1371
Practice Address - Fax:504-731-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3061 (PCA)320900000X
LA3060 (SIL)320900000X
LA6879 (RESPITE)320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1989649OtherMEDICAID- SIL
LA1989631OtherMEDICAID- IFS