National Provider Identifier Database

MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC
Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)


Contact Information

MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.
2005 CRESWELL AVE
SHREVEPORT, LA71104-2201
Phone: 318-676-0705
Fax: 318-676-0709
Website:
Specialty Taxonomy Code
* Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X

* Indicates primary specialty

NPI Profile & details for MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.

NPI Number 1407853716
Legal business name
LBN
MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.
Authorized official DEWARRENT BRANTLEY - (CEO/PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 06/30/2005
Last updated 08/18/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • LA Medicaid: 1159310

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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