MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC. NPI 1407853716

NPI Information

NPI: 1407853716
Provider Name: MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.
Classification: Clinic/Center - 261QR0401X
Entity Type: Organization

Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)

Address:
2005 CRESWELL AVE
SHREVEPORT, LA
ZIP 71104
Phone: (318) 676-0705
Get Directions

MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC. is a rehabilitation and comprehensive outpatient rehabilitation facility (corf) clinic center in Shreveport, LA. MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC. NPI is 1407853716. The provider is registered as an organization entity type.

The provider's business location address is:

2005 CRESWELL AVE
SHREVEPORT, LA
ZIP 71104-201
Phone: (318) 676-0705
Fax: (318) 676-0709

The provider's authorized official is Dewarrent Lee Brantley .
The authorized official title is Ceo/president and has the following contact phone number (318) 676-0705.

The enumeration date for this NPI number is 6/30/2005 and was last updated on 8/18/2011.

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	261QR0401X	Clinic/Center	Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)			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	1159310	MEDICAID	LOUISIANA
2	=========	OTHER	LOUISIANA	TRI-CARESOUTHWEST
3	=========0	OTHER	LOUISIANA	BLUECROSSBLUESHEILD OF LA

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: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »