Provider Demographics
NPI:1386213833
Name:MAGNOLIA HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOME HEALTH CARE, LLC
Other - Org Name:MAGNOLIA HOME HEALTH CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-662-6153
Mailing Address - Street 1:4144 LINDELL BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2954
Mailing Address - Country:US
Mailing Address - Phone:314-260-9210
Mailing Address - Fax:314-260-9019
Practice Address - Street 1:4144 LINDELL BLVD STE 407
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2954
Practice Address - Country:US
Practice Address - Phone:314-662-6153
Practice Address - Fax:314-733-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO372500000XMedicaid