Provider Demographics
NPI:1043652704
Name:MAGNOLIA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:602-373-7052
Mailing Address - Street 1:PO BOX 20015
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86341-0015
Mailing Address - Country:US
Mailing Address - Phone:928-284-1500
Mailing Address - Fax:866-284-2849
Practice Address - Street 1:6560 SR 179 STE 208
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-6923
Practice Address - Country:US
Practice Address - Phone:928-284-1500
Practice Address - Fax:866-284-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health