# MAGNOLIA MANOR NURSING & REHAB CNTR LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Magnolia Manor Nursing & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740261411
- **Authorized official:** MR. TEDDY RAY PRICE (MANAGING MEMBER)
- **Authorized official phone:** (318) 628-4116

## Contact information

- **Practice address:** 1411 CLAIBORNE AVE, SHREVEPORT, LA 71103-4203
- **Practice address phone:** (318) 868-4421
- **Practice address fax:** (318) 868-4431
- **Mailing address:** PO BOX 38270, SHREVEPORT, LA 71133-8270
- **Mailing address phone:** (318) 868-4421
- **Mailing address fax:** (318) 868-4431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 204 | LA | Yes |

## Other

- **Enumeration date:** 11/09/2005
- **Last updated:** 09/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1517186 | — | LA |