| Organization Name: | MAGNOLIA REHABILIATION SERVICES INC |
| NPI Number: | 1881691194 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEWARRENT LEE BRANTLEY (CEO/ PRESIDENT) |
| Mailing Address: | 2005 Creswell Ave 4908 P.o.box Shreveport La .71134 Shreveport |
| State: | LA US |
| Postal Code: | 711042201 |
| Phone Number: | 3186763762 |
| Fax Number: | 3186763083 |
| NPI Enumeration Date: | 06/30/2005 |
| NPI Last Update Date: | 06/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 5CF64 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |