Healthcare Provider Details

I. General information

NPI: 1700912573
Provider Name (Legal Business Name): MAGNOLIA RESPITE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 FLORIDA BLVD
BATON ROUGE LA
70815-4026
US

IV. Provider business mailing address

8924 FLORIDA BLVD
BATON ROUGE LA
70815-4026
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-5080
  • Fax: 225-928-5040
Mailing address:
  • Phone: 225-928-5080
  • Fax: 225-928-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ETHEL COMEAUX
Title or Position: DIRECTOR
Credential: DIRECTOR
Phone: 225-928-5080