MEDICARE: YOUR CARE FACILITY MAGNOLIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1538091293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CARE FACILITY MAGNOLIA LLC

Provider Business Mailing Address
First Line	:	402 DUNCAN PERRY RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2907
Country	:	US
Telephone Number	:	972-206-0402
Fax Number	:	972-206-0408

Provider Business Practice Location Address
First Line	:	402 DUNCAN PERRY RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2907
Country	:	US
Telephone Number	:	972-206-0402
Fax Number	:	972-206-0408

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DANIEL WHITFIELD
Credential	:
Telephone Number	:	945-946-5025

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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