Provider Demographics
NPI: | 1649397035 |
---|---|
Name: | MAGNA HOME HEALTH CARE INC |
Entity Type: | Organization |
Organization Name: | MAGNA HOME HEALTH CARE INC |
Other - Org Name: | MAGNA HEALTH CARE SERVICES |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CHRISTIANA |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | AGBASI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 918-459-5074 |
Mailing Address - Street 1: | 4271 W ALBANY ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BROKEN ARROW |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74012-1233 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-459-5073 |
Mailing Address - Fax: | 918-459-5075 |
Practice Address - Street 1: | 4271 W ALBANY ST |
Practice Address - Street 2: | |
Practice Address - City: | BROKEN ARROW |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74012-1233 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-459-5073 |
Practice Address - Fax: | 918-459-5075 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 7410 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |