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General NPI Number Information
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NPI Number | 1790159358
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HOSPICE, LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 1018 N GLOSTER ST STE J
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City | TUPELO
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State | MS
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Zip | 38804-1234
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Country | US
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Telephone | 662-890-5554
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Fax | 662-890-5746
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Provider Business Mailing Address
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Address Line | 2200 S BOWMAN RD STE A
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4136
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Country | US
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Telephone | 501-558-4100
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Fax | 501-296-9978
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Authorized Official
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Title or Position | MANAGER/COO
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Name | MRS. KRISTI KENSLOW
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Credential |
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Telephone | 501-558-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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