Healthcare Provider Details

I. General information

NPI: 1437940897
Provider Name (Legal Business Name): MAGNOLIA ANGELS ADULT DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7662 US 31
INDIANAPOLIS IN
46227-8547
US

IV. Provider business mailing address

7662 US 31
INDIANAPOLIS IN
46227-8547
US

V. Phone/Fax

Practice location:
  • Phone: 317-220-8499
  • Fax:
Mailing address:
  • Phone: 317-220-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MYKESHIA BURTON
Title or Position: OWNER
Credential:
Phone: 217-220-8499