Organization
MAGNOLIA REHABILITATION SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEWARRENT LEE BRANTLEY (OWNER/CEO)
(318) 840-9074
Entity
Organization
Contact information
Practice address
4005 LAKESHORE DR, SHREVEPORT, LA 71109-1927
(337) 324-8465
(318) 676-3083
Mailing address
4005 LAKESHORE DR, SHREVEPORT, LA 71109-1927
(318) 840-9074
(318) 860-3025
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
5CF64
LA
Other
Enumeration date
06/30/2005
Last updated
06/04/2025
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