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General NPI Number Information
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NPI Number | 1801260468
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Entity Type | Organization
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Legal Business Name | MAGNOLIA COMMUNITY SERVICES, INC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 143 CENTRAL AVE
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City | JEFFERSON
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State | LA
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Zip | 70121-3401
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Country | US
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Telephone | 504-304-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CENTRAL AVE
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City | JEFFERSON
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State | LA
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Zip | 70121-3402
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Country | US
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Telephone | 504-733-2874
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JENNIFER HEBERT
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Credential |
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Telephone | 504-731-1324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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