Provider Demographics
NPI:1053058586
Name:MAGNIFICENT HEALTH CARE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MAGNIFICENT HEALTH CARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN JUNNEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAROLINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:213-842-6224
Mailing Address - Street 1:14545 FRIAR ST STE 397
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:818-646-7866
Mailing Address - Fax:818-647-6775
Practice Address - Street 1:14545 FRIAR ST STE 397
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:818-646-7866
Practice Address - Fax:818-647-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5017100OtherENTITY NO