Provider Demographics
NPI:1649079013
Name:MAGNOLIA RECOVERY COMMUNITY
Entity type:Organization
Organization Name:MAGNOLIA RECOVERY COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-454-9938
Mailing Address - Street 1:3601 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-5560
Mailing Address - Country:US
Mailing Address - Phone:501-454-9938
Mailing Address - Fax:
Practice Address - Street 1:3601 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-5560
Practice Address - Country:US
Practice Address - Phone:501-454-9938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health