Organization
MAGNOLIA HEALTHCARE, INC.
Active
Other names
Autumn Leaves Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD THOMAS DASPIT SR. (CEO)
(225) 906-4644
Entity
Organization
Contact information
Practice address
570 SOLOMON ST, GREENVILLE, MS 38703-2771
(662) 335-5863
(662) 335-5874
Mailing address
PO BOX 40018, BATON ROUGE, LA 70835-0018
(225) 753-0864
(225) 753-0948
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
494
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220307
—
MS
Enumeration date
10/11/2006
Last updated
09/11/2019
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