Healthcare Provider Details

I. General information

NPI: 1396338638
Provider Name (Legal Business Name): MAGIC HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 BRACKS LANDING DR
SAINT CLOUD FL
34771-8064
US

IV. Provider business mailing address

5242 BRACKS LANDING DR
SAINT CLOUD FL
34771-8064
US

V. Phone/Fax

Practice location:
  • Phone: 787-383-1437
  • Fax:
Mailing address:
  • Phone: 787-383-1437
  • 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: MR. KEVIN O RIVERA SR.
Title or Position: NURSE ADMINISTRADOR
Credential: RN
Phone: 787-383-1437