Healthcare Provider Details

I. General information

NPI: 1033066154
Provider Name (Legal Business Name): MAGNOLIA HEALTH AND WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 DEGROODT ST SW
PALM BAY FL
32908
US

IV. Provider business mailing address

880 DEGROODT ST SW
PALM BAY FL
32908
US

V. Phone/Fax

Practice location:
  • Phone: 321-333-5642
  • Fax:
Mailing address:
  • Phone: 321-333-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA CHRISTIAN
Title or Position: ADMINISTRATOR
Credential: CNA
Phone: 772-626-1413