Provider Demographics
NPI:1801389218
Name:MAGNOLIA HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:MAGNOLIA HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI-OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-517-7310
Mailing Address - Street 1:1021 STUYVESANT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6029
Mailing Address - Country:US
Mailing Address - Phone:973-517-7310
Mailing Address - Fax:
Practice Address - Street 1:1021 STUYVESANT AVE STE 2
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6029
Practice Address - Country:US
Practice Address - Phone:973-517-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health