Healthcare Provider Details

I. General information

NPI: 1518735950
Provider Name (Legal Business Name): MAGNOLIA CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 N FREDERIC ST
BURBANK CA
91504-1719
US

IV. Provider business mailing address

3017 N FREDERIC ST
BURBANK CA
91504-1719
US

V. Phone/Fax

Practice location:
  • Phone: 818-644-7505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ELLA UNDZHYAN
Title or Position: CEO
Credential:
Phone: 818-644-7505