Provider Demographics
NPI:1225207020
Name:MAGNOLIA HOME HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:MAGNOLIA HOME HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMENUHI
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:KESHISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-566-4411
Mailing Address - Street 1:120 S VICTORY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2801
Mailing Address - Country:US
Mailing Address - Phone:818-566-4411
Mailing Address - Fax:818-566-4404
Practice Address - Street 1:120 S VICTORY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2801
Practice Address - Country:US
Practice Address - Phone:818-566-4411
Practice Address - Fax:818-566-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001035251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059165Medicare Oscar/Certification