Provider Demographics
NPI:1235686130
Name:FREEDOM HOSPITAL OF MAGNOLIA LLC
Entity type:Organization
Organization Name:FREEDOM HOSPITAL OF MAGNOLIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-802-1336
Mailing Address - Street 1:PO BOX 7935
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-7935
Mailing Address - Country:US
Mailing Address - Phone:337-802-1336
Mailing Address - Fax:
Practice Address - Street 1:120 E MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2834
Practice Address - Country:US
Practice Address - Phone:601-783-2353
Practice Address - Fax:601-783-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health