Healthcare Provider Details

I. General information

NPI: 1093725871
Provider Name (Legal Business Name): MAGNOLIA'S HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 W. UNIVERSITY AVE
LAFAYETTE LA
70506-2545
US

IV. Provider business mailing address

P O BOX 2547
LAFAYETTE LA
70502-2547
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-4351
  • Fax: 337-232-4352
Mailing address:
  • Phone: 337-232-4351
  • Fax: 337-232-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number12300
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number12278
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number12300
License Number StateLA

VIII. Authorized Official

Name: MRS. EMILIE L DUHON
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-232-4351