Provider Demographics
NPI:1174033278
Name:MAGNIFICENT HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:MAGNIFICENT HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VANKAMOH
Authorized Official - Middle Name:LUSENE
Authorized Official - Last Name:SHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:614-377-0005
Mailing Address - Street 1:108 LINDA CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4928
Mailing Address - Country:US
Mailing Address - Phone:614-377-0005
Mailing Address - Fax:
Practice Address - Street 1:108 LINDA CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4928
Practice Address - Country:US
Practice Address - Phone:614-377-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty