Organization
MAGNOLIA MEDICAL RESOURCES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JO ANN GUTEKUNST (OWNER)
(337) 439-4729
Entity
Organization
Contact information
Practice address
412 7TH ST, LAKE CHARLES, LA 70601-6007
(337) 439-4729
Mailing address
412 7TH ST, LAKE CHARLES, LA 70601-6007
(337) 439-4729
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
PCA 4292
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1974757
—
LA
Enumeration date
04/10/2007
Last updated
06/25/2008
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