Healthcare Provider Details

I. General information

NPI: 1891324042
Provider Name (Legal Business Name): MAGNOLIA HOME HEALTH, LLC DBA HOME INSTEAD SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 FOREST PARK DRIVE, SUITE B
SAVANNAH GA
31406
US

IV. Provider business mailing address

6709 FOREST PARK DRIVE, SUITE B
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-0099
  • Fax: 912-355-0181
Mailing address:
  • Phone: 912-355-0099
  • Fax: 912-355-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHANE THOMPSON
Title or Position: CO-OWNER/PRESIDENT
Credential:
Phone: 904-502-5990