Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.

Practice address

2005 Creswell Ave
Shreveport, LA 71104-2201

Phone

(318) 676-0705

Fax

(318) 676-0709

NPI assigned

Jun 30, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Dewarrent Lee Brantley

Title

Ceo/President

Phone

(318) 676-0705

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1407853716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-676-0705",
            "fax_number": "318-676-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-676-0705",
            "fax_number": "318-676-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA COMPREHENSIVE OUTPATIENT REHABILIATION FACILITY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "DEWARRENT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "318-676-0705",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1159310",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason L Maggio, D.C.
• Rebecca Prince Maggio, LOTR
• Christopher Micheal Magill, PA-C
• Nan Magness, LPC
• Magnolia Community Mental Health Facility Inc.
• Magnolia Diagnostic Services Inc.
• Magnolia Diagonstic Services Inc.
• Magnolia Durable Medical Equipment Inc.
• Magnolia Family Support & Interventions, LLC
• Magnolia Intergrated Healthcare Services Inc

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; 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.