Organization
MAGNOLIA OF MADISON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL LEN MACHEN R.N. (ADMINISTRATOR, DON)
(318) 574-6400
Entity
Organization
Contact information
Practice address
708 LASALLE ST., TALLULAH, LA 71282
(318) 574-6400
(318) 574-6401
Mailing address
708 LASALLE ST., TALLULAH, LA 71282
(318) 574-6400
(318) 574-6401
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
860
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1406503
—
LA
Enumeration date
06/08/2005
Last updated
08/22/2020
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