Healthcare Provider Details

I. General information

NPI: 1972482842
Provider Name (Legal Business Name): MAGNOLIA IN-HOME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 LINDELL BLVD STE 312
SAINT LOUIS MO
63108-2953
US

IV. Provider business mailing address

4144 LINDELL BLVD STE 312
SAINT LOUIS MO
63108-2953
US

V. Phone/Fax

Practice location:
  • Phone: 314-305-4218
  • Fax: 314-305-4218
Mailing address:
  • Phone: 314-305-4218
  • Fax: 314-305-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOYCE MCGEE
Title or Position: DIRECTOR
Credential: DO
Phone: 314-305-4218