Magnolia Rehabilitation Services Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

5CF64 Issued in LA

Legal business name

MAGNOLIA REHABILITATION SERVICES INC

Practice address

4005 Lakeshore Dr
Shreveport, LA 71109-1927

Phone

(337) 324-8465

Fax

(318) 676-3083

NPI assigned

Jun 30, 2005

Last updated

Jun 4, 2025By the provider in NPPES

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

Owner/Ceo

Phone

(318) 840-9074

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA, NJ2 enrollments

Enrollment records 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darlinda Theresa Dove, FNP

  • Family Nurse Practitioner
  • Glenmora, LA
  • NPI 1003329871
  Medicare reassignment NPD
• Steve O Odeh, M.D

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bremen, GA
  • NPI 1801940200

  NJ

  Medicare reassignment NPD
• Rosalind Annette Cropper, MD

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1124243837
  NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1881691194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 LAKESHORE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711091927",
            "telephone_number": "318-840-9074",
            "fax_number": "318-860-3025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 LAKESHORE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711091927",
            "telephone_number": "337-324-8465",
            "fax_number": "318-676-3083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Broadway Ste 68",
            "address_purpose": "LOCATION",
            "city": "Paterson",
            "state": "NJ",
            "postal_code": "075141524",
            "country_code": "US",
            "telephone_number": "318-840-9074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA REHABILITATION SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "DEWARRENT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "318-840-9074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "LA",
            "license": "5CF64",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magnolia Medical Internal Medicine Inc
• Magnolia Medical LLC
• Magnolia Mental Health LLC
• Magnolia Recovery, LLC
• Magnolia Recovery, LLC (Magnolia Recovery Clinic)
• Magnolia Transportation Services Inc.
• Siddharth Mahajan
• Susan L Mahaney
• Sangam Mahat, MD
• Nidal A. Mahgoub, MD

• Multi-Specialty Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Multi-Specialty Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.