Provider Demographics
NPI:1134774938
Name:HOUSE OF MAGNOLIA'S HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:HOUSE OF MAGNOLIA'S HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-496-5223
Mailing Address - Street 1:1802 W HIGHWAY 378
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29546-4080
Mailing Address - Country:US
Mailing Address - Phone:843-496-5223
Mailing Address - Fax:
Practice Address - Street 1:1802 W HIGHWAY 378
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:SC
Practice Address - Zip Code:29546-4080
Practice Address - Country:US
Practice Address - Phone:843-496-5223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty