NPIMap

Organization Active NPI

Magnolia of Madison, Inc.

  • Home Health Agency
  • Tallulah, LA
National Provider Identifier
1376547349
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
860 Issued in LA
Legal business name
MAGNOLIA OF MADISON, INC.
Practice address
708 Lasalle St.
Tallulah, LA 71282
Phone
(318) 574-6400
Fax
(318) 574-6401
NPI assigned
Jun 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Carl Len Machen, R.N.
Title
Administrator, Don
Phone
(318) 574-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 860 LA Primary

Addresses

Primary practice location

708 Lasalle St.
Tallulah, LA 71282

Mailing address

708 Lasalle St.
Tallulah, LA 71282
Phone (318) 574-6400

Other identifiers 1

IdentifierTypeStateIssuer
1406503MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376547349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 LASALLE ST.",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "71282",
            "telephone_number": "318-574-6400",
            "fax_number": "318-574-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 LASALLE ST.",
            "city": "TALLULAH",
            "state": "LA",
            "postal_code": "71282",
            "telephone_number": "318-574-6400",
            "fax_number": "318-574-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA OF MADISON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MACHEN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "LEN",
        "authorized_official_title_or_position": "ADMINISTRATOR, DON",
        "authorized_official_telephone_number": "318-574-6400",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "LA",
            "license": "860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1406503",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallulah, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.