Provider Demographics
NPI:1609237064
Name:MAGNUS VETERANS REBIRTH NPO
Entity Type:Organization
Organization Name:MAGNUS VETERANS REBIRTH NPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-926-0242
Mailing Address - Street 1:19464 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2174
Mailing Address - Country:US
Mailing Address - Phone:313-926-0242
Mailing Address - Fax:313-740-7057
Practice Address - Street 1:19464 FAUST AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2174
Practice Address - Country:US
Practice Address - Phone:313-926-0242
Practice Address - Fax:313-740-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health