Healthcare Provider Details

I. General information

NPI: 1316063266
Provider Name (Legal Business Name): MAGNA HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 W ALBANY ST
BROKEN ARROW OK
74012-1233
US

IV. Provider business mailing address

4271 W ALBANY ST
BROKEN ARROW OK
74012-1233
US

V. Phone/Fax

Practice location:
  • Phone: 918-459-5074
  • Fax: 918-459-5075
Mailing address:
  • Phone: 918-459-5074
  • Fax: 918-459-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD AGBASI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 918-459-5074