Provider Demographics
NPI:1871953802
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-802-1336
Mailing Address - Street 1:205 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-2819
Mailing Address - Country:US
Mailing Address - Phone:601-783-2353
Mailing Address - Fax:601-783-9003
Practice Address - Street 1:205 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2819
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:2016-03-03
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MS16-275273R00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20043Medicaid
MS20043Medicaid
MS25S049Medicare Oscar/Certification