Provider Demographics
NPI:1770233108
Name:MAGNOLIA HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:MAGNOLIA HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-830-8898
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-7215
Mailing Address - Country:US
Mailing Address - Phone:224-830-8898
Mailing Address - Fax:
Practice Address - Street 1:1039 E 146TH ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2342
Practice Address - Country:US
Practice Address - Phone:872-731-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care