MAGNOLIA PEC LLC NPI 1053913442

NPI Information

NPI: 1053913442
Provider Name: MAGNOLIA PEC, LLC
Classification: Clinic/Center - 261QM3000X
Specialization: Medically Fragile Infants and Children Day Care
Entity Type: Organization
CLIA Number: 25D2228976
Address: 404 N 12TH AVE
LAUREL, MS
ZIP 39440
Phone: (601) 682-1250

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NPI Details

MAGNOLIA PEC, LLC is a medically fragile infants and children day care clinic center in Laurel, MS. The provider is an entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.). MAGNOLIA PEC, LLC NPI is 1053913442. The provider is registered as an organization entity type.

The provider's business location address is:

404 N 12TH AVE
LAUREL, MS
ZIP 39440-876
Phone: (601) 682-1250
Fax: (601) 682-1256

The provider's authorized official is Elizabeth Brister .
The authorized official title is Owner and has the following contact phone number (318) 323-1930.

The CLIA number assigned to this NPI record is 25D2228976 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2020 and was last updated on 2/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM3000X	Clinic/Center	Medically Fragile Infants and Children Day Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	007828091	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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