Healthcare Provider Details

I. General information

NPI: 1114725090
Provider Name (Legal Business Name): MAGNOLIA HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E SHAW AVE STE 105
FRESNO CA
93710-7838
US

IV. Provider business mailing address

1130 E SHAW AVE STE 105
FRESNO CA
93710-7838
US

V. Phone/Fax

Practice location:
  • Phone: 555-375-1718
  • Fax: 559-421-1987
Mailing address:
  • Phone: 559-375-1718
  • Fax: 559-421-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CINDERELA IVORY CO ECHOLS
Title or Position: CHIEF OPERATING OFFICER
Credential: RN, ESQ
Phone: 559-375-1718