Provider Demographics
NPI:1154974913
Name:MAGNOLIA HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:MAGNOLIA HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRO
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-267-2005
Mailing Address - Street 1:951 NE LOWRY AVE #314
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418
Mailing Address - Country:US
Mailing Address - Phone:612-267-2005
Mailing Address - Fax:
Practice Address - Street 1:951 NE LOWRY AVE #314
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-267-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)