Healthcare Provider Details

I. General information

NPI: 1770233108
Provider Name (Legal Business Name): MAGNOLIA HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19710 GOVERNORS HWY STE 5-1195
FLOSSMOOR IL
60422-2080
US

IV. Provider business mailing address

PO BOX 1215
DOLTON IL
60419-7215
US

V. Phone/Fax

Practice location:
  • Phone: 708-487-9029
  • Fax: 708-487-9031
Mailing address:
  • Phone: 708-487-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AUDREY HAYMER
Title or Position: MANAGER
Credential:
Phone: 224-830-8898