Provider Demographics
NPI:1497036701
Name:MAGNOLIA HOME CARE, INC.
Entity Type:Organization
Organization Name:MAGNOLIA HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:662-719-8491
Mailing Address - Street 1:918 NINTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3638
Mailing Address - Country:US
Mailing Address - Phone:662-719-8491
Mailing Address - Fax:
Practice Address - Street 1:918 NINTH AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-3638
Practice Address - Country:US
Practice Address - Phone:662-719-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770590Medicaid