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General NPI Number Information
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NPI Number | 1558697912
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MEDICAL STAFFING, LLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 2440 PAIGE JANETTE DR
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City | HARVEY
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State | LA
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Zip | 70058-2137
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Country | US
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Telephone | 504-371-1149
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 PAIGE JANETTE DR
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City | HARVEY
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State | LA
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Zip | 70058
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Country | US
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Telephone | 504-371-1149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROY ELDRIDGE COOPER JR.
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Credential | CRTT
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Telephone | 504-371-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | LT1454
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License Number State | LA
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