Provider Demographics
NPI:1346611472
Name:MAGNOLIA HOME CARE SERVICES INC.
Entity Type:Organization
Organization Name:MAGNOLIA HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABIDEMI
Authorized Official - Middle Name:I
Authorized Official - Last Name:FIJABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-747-6200
Mailing Address - Street 1:2400 GENEVA LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5047
Mailing Address - Country:US
Mailing Address - Phone:630-747-6200
Mailing Address - Fax:
Practice Address - Street 1:2400 GENEVA LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5047
Practice Address - Country:US
Practice Address - Phone:630-747-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health