Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.

LBN: Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.
Magnolia Comprehensive Outpatient Rehabiliation Facility Inc. is an health care organization with primary practice located at 2005 Creswell Ave , Shreveport LA 71104-2201. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF), which is considered as the primary health care specialty. Magnolia Comprehensive Outpatient Rehabiliation Facility Inc. can be contacted via phone (318) 676-0705, or through Brantley, Dewarrent Lee via phone (318) 676-0705.

Contact Information

Primary practice address
2005 Creswell Ave Shreveport LA 71104-2201
Phone: (318) 676-0705
Fax: (318) 676-0709
Website:
Map and Directions
Authorized official contact:
Name: Brantley, Dewarrent Lee
Phone: (318) 676-0705

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X

Profile Details

NPI number 1407853716
LBN Legal business name Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.
DBA Doing business as
Authorized official Brantley, Dewarrent Lee
Entity Organization
Organization subpart 1 No
Enumeration date Jun 30th, 2005
Last updated Aug 18th, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407853716 NPPES
Louisiana MEDICAID 1159310

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