Magnolia Pec, LLC

Primary specialty

Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X

Legal business name

MAGNOLIA PEC, LLC

Practice address

404 N 12TH Ave
Laurel, MS 39440-3876

Phone

(601) 682-1250

Fax

(601) 682-1256

NPI assigned

Nov 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Brister

Title

Owner

Phone

(318) 323-1930

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1053913442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2403",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71207",
            "telephone_number": "318-323-1930",
            "fax_number": "318-323-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 N 12TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403876",
            "telephone_number": "601-682-1250",
            "fax_number": "601-682-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PEC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-11",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "BRISTER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-323-1930"
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007828091",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ereyanna Jonay Magee, PHARMD
• Shalacey Magee
• Magnolia Gardens Assisted Living
• Magnolia Gardens Assisted Living, Inc
• Magnolia Gardens Assisted Living, Inc
• Autumn Makamson
• Theresa Mann, CRTT/RRTE
• Joshua Brett Manning, PHARMD
• Rochelle Z. Manning, SLP
• Constance Hope Marshall, MOTR/L

• Medically Fragile Infants and Children Day Care in Laurel, MS
• Providers in Laurel, MS by specialty
• Medically Fragile Infants and Children Day Care in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.