Provider Demographics
NPI:1053303701
Name:MAGNA HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:MAGNA HOME HEALTH CARE INC.
Other - Org Name:MAGNA HEALTH CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGBASI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-459-5073
Mailing Address - Street 1:4271 W ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1233
Mailing Address - Country:US
Mailing Address - Phone:918-459-5073
Mailing Address - Fax:918-459-5075
Practice Address - Street 1:4271 W ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1233
Practice Address - Country:US
Practice Address - Phone:918-459-5073
Practice Address - Fax:918-459-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7410251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
377497Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER