Healthcare Provider Details

I. General information

NPI: 1548890767
Provider Name (Legal Business Name): MAGNIFICENT TOUCH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 CHIPPENDALE AVE
PHILADELPHIA PA
19136-3604
US

IV. Provider business mailing address

4224 CHIPPENDALE AVE
PHILADELPHIA PA
19136-3604
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-4258
  • Fax:
Mailing address:
  • Phone: 267-240-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. SHONDA VAUGHN
Title or Position: OWNER
Credential:
Phone: 267-240-4258