Healthcare Provider Details

I. General information

NPI: 1013628593
Provider Name (Legal Business Name): MAGNOLIA ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 NW 7TH CT
BOYNTON BEACH FL
33426-9340
US

IV. Provider business mailing address

4745 NW 7TH CT
BOYNTON BEACH FL
33426-9340
US

V. Phone/Fax

Practice location:
  • Phone: 720-934-1122
  • Fax: 303-484-4024
Mailing address:
  • Phone: 720-934-1122
  • Fax: 303-484-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD RUVINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-934-1122