Provider Demographics
NPI:1174267603
Name:MAGNA CARE SERVICES LLC
Entity Type:Organization
Organization Name:MAGNA CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RIVAS
Authorized Official - Last Name:GARAYGAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:636-265-3185
Mailing Address - Street 1:711 STONEWOOD BEND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4064
Mailing Address - Country:US
Mailing Address - Phone:636-265-3185
Mailing Address - Fax:
Practice Address - Street 1:711 STONEWOOD BEND DR
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-4064
Practice Address - Country:US
Practice Address - Phone:636-265-3185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty