Provider Demographics
NPI:1942843115
Name:MAGNUSSON ENTERPRISES LLC
Entity Type:Organization
Organization Name:MAGNUSSON ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BSN, RN
Authorized Official - Phone:650-653-1934
Mailing Address - Street 1:36 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5109
Mailing Address - Country:US
Mailing Address - Phone:650-343-6770
Mailing Address - Fax:
Practice Address - Street 1:36 42ND AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-5109
Practice Address - Country:US
Practice Address - Phone:650-343-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care