Healthcare Provider Details

I. General information

NPI: 1598371023
Provider Name (Legal Business Name): MSHC MAGNOLIA AT THE OAKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 RICHMOND MDWS
TEXARKANA TX
75503-0103
US

IV. Provider business mailing address

4939 ELIZABETH ST
TEXARKANA TX
75503-2911
US

V. Phone/Fax

Practice location:
  • Phone: 903-832-0429
  • Fax:
Mailing address:
  • Phone: 903-832-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CARLA POWER
Title or Position: CFO
Credential:
Phone: 903-832-0429