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General NPI Number Information
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NPI Number | 1063641355
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Entity Type | Organization
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Legal Business Name | MAGNIFICENT HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 3345 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2234
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Country | US
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Telephone | 708-499-0321
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Fax | 708-499-0360
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Provider Business Mailing Address
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Address Line | 3345 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2234
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Country | US
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Telephone | 708-499-0321
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Fax | 708-499-0360
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | MR. BERNARD A JAVATE
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Credential |
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Telephone | 708-499-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1011027
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License Number State | IL
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