Provider Demographics
NPI:1518452523
Name:MAGNOLIA AFFORDABLE HOME CARE LLC
Entity Type:Organization
Organization Name:MAGNOLIA AFFORDABLE HOME CARE LLC
Other - Org Name:MAGNOLIA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AYANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-365-8517
Mailing Address - Street 1:204 MUIRS CHAPEL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6176
Mailing Address - Country:US
Mailing Address - Phone:336-365-8517
Mailing Address - Fax:
Practice Address - Street 1:204 MUIRS CHAPEL RD STE 301
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6176
Practice Address - Country:US
Practice Address - Phone:336-365-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty