Organization
MAGNOLIA MANOR NURSING & REHAB CNTR LLC
Active
Other names
Magnolia Manor Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEDDY RAY PRICE (MANAGING MEMBER)
(318) 628-4116
Entity
Organization
Contact information
Practice address
1411 CLAIBORNE AVE, SHREVEPORT, LA 71103-4203
(318) 868-4421
(318) 868-4431
Mailing address
PO BOX 38270, SHREVEPORT, LA 71133-8270
(318) 868-4421
(318) 868-4431
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
204
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517186
—
LA
Enumeration date
11/09/2005
Last updated
09/12/2024
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