Provider Demographics
NPI:1013905561
Name:MAGNOLIA HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:MAGNOLIA HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDS CO ORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-234-7000
Mailing Address - Street 1:600 LELIA ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4035
Mailing Address - Country:US
Mailing Address - Phone:870-234-7000
Mailing Address - Fax:870-234-7168
Practice Address - Street 1:600 LELIA ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-4035
Practice Address - Country:US
Practice Address - Phone:870-234-7000
Practice Address - Fax:870-234-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR746314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154004311Medicaid
AR154004311Medicaid