Provider Demographics
NPI:1063641355
Name:MAGNIFICENT HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MAGNIFICENT HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAVATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-499-0321
Mailing Address - Street 1:3345 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2234
Mailing Address - Country:US
Mailing Address - Phone:708-499-0321
Mailing Address - Fax:708-499-0360
Practice Address - Street 1:3345 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2234
Practice Address - Country:US
Practice Address - Phone:708-499-0321
Practice Address - Fax:708-499-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health