Healthcare Provider Details

I. General information

NPI: 1174267603
Provider Name (Legal Business Name): MAGNA CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STONEWOOD BEND DR
LAKE ST LOUIS MO
63367-4064
US

IV. Provider business mailing address

711 STONEWOOD BEND DR
LAKE ST LOUIS MO
63367-4064
US

V. Phone/Fax

Practice location:
  • Phone: 636-265-3185
  • Fax:
Mailing address:
  • Phone: 636-265-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RIVAS GARAYGAY
Title or Position: PRESIDENT
Credential: PT
Phone: 636-265-3185