Healthcare Provider Details

I. General information

NPI: 1720669989
Provider Name (Legal Business Name): MAGNIFICENT HEALTHCARE & CPR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 W DEVON AVE
CHICAGO IL
60659-2241
US

IV. Provider business mailing address

6443 N HOYNE AVE
CHICAGO IL
60645-5850
US

V. Phone/Fax

Practice location:
  • Phone: 312-685-5243
  • Fax:
Mailing address:
  • Phone: 312-685-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARGARET OKODUA
Title or Position: ADMINISTRATOR
Credential: DNP, APN, RN
Phone: 773-856-3202