Provider Demographics
NPI:1295190783
Name:MAGNIFICARE, LLC
Entity Type:Organization
Organization Name:MAGNIFICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-702-1995
Mailing Address - Street 1:1654 BELLTOWER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3201
Mailing Address - Country:US
Mailing Address - Phone:202-642-7520
Mailing Address - Fax:
Practice Address - Street 1:1654 BELLTOWER DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3201
Practice Address - Country:US
Practice Address - Phone:202-642-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care