Provider Demographics
NPI:1952622466
Name:MAGICTOUCHSOUTHERNLIVINGLLC
Entity Type:Organization
Organization Name:MAGICTOUCHSOUTHERNLIVINGLLC
Other - Org Name:MAGIC TOUCH PRIVATE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-400-0318
Mailing Address - Street 1:2039 HWY 111 NORTH
Mailing Address - Street 2:2039
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828
Mailing Address - Country:US
Mailing Address - Phone:229-400-0318
Mailing Address - Fax:
Practice Address - Street 1:2039 HWY 111 NORTH
Practice Address - Street 2:2039
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828
Practice Address - Country:US
Practice Address - Phone:229-400-0318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGICTOUCHSOUTHERNLIVINGLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-18
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health