Provider Demographics
NPI:1700912573
Name:MAGNOLIA RESPITE CARE INC.
Entity Type:Organization
Organization Name:MAGNOLIA RESPITE CARE INC.
Other - Org Name:MAGNOLIA RESPITE CARE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:225-928-5080
Mailing Address - Street 1:8924 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4026
Mailing Address - Country:US
Mailing Address - Phone:225-928-5080
Mailing Address - Fax:225-928-5040
Practice Address - Street 1:8924 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4026
Practice Address - Country:US
Practice Address - Phone:225-928-5080
Practice Address - Fax:225-928-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1741230Medicaid
LA1741230Medicaid