Healthcare Provider Details

I. General information

NPI: 1235686130
Provider Name (Legal Business Name): FREEDOM HOSPITAL OF MAGNOLIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MYRTLE ST
MAGNOLIA MS
39652-2834
US

IV. Provider business mailing address

PO BOX 7935
LAKE CHARLES LA
70606-7935
US

V. Phone/Fax

Practice location:
  • Phone: 601-783-2353
  • Fax: 601-783-9003
Mailing address:
  • Phone: 337-802-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY J REED
Title or Position: CEO
Credential:
Phone: 337-802-1336