Organization
THE MAGNOLIA SCHOOL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH ANNE MERIDA (DIR. OF SIL SERVICES)
(504) 731-1371
Entity
Organization
Contact information
Practice address
100 CENTRAL AVE, JEFFERSON, LA 70121-3402
(504) 731-1371
(504) 731-1354
Mailing address
100 CENTRAL AVE, JEFFERSON, LA 70121-3402
(504) 731-1371
(504) 731-1354
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
3060 (SIL)
LA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3061 (PCA)
LA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6879 (RESPITE)
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1989631
MEDICAID- IFS
LA
01
—
1989649
MEDICAID- SIL
LA
Enumeration date
03/16/2009
Last updated
03/16/2009
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