Provider Demographics
NPI:1639304728
Name:MAGIC CITY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:MAGIC CITY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-637-8869
Mailing Address - Street 1:1780 WESTLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3322
Mailing Address - Country:US
Mailing Address - Phone:307-637-8869
Mailing Address - Fax:307-638-0467
Practice Address - Street 1:1780 WESTLAND RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3322
Practice Address - Country:US
Practice Address - Phone:307-637-8869
Practice Address - Fax:307-638-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services