Healthcare Provider Details

I. General information

NPI: 1750217493
Provider Name (Legal Business Name): MAGNIFICENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 W FLORISSANT AVE
SAINT LOUIS MO
63136-4952
US

IV. Provider business mailing address

5933 W FLORISSANT AVE
SAINT LOUIS MO
63136-4952
US

V. Phone/Fax

Practice location:
  • Phone: 314-583-9443
  • Fax:
Mailing address:
  • Phone: 314-583-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTWONE MOORE JR.
Title or Position: MANAGER
Credential:
Phone: 314-583-9443