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General NPI Number Information
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NPI Number | 1376011825
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Entity Type | Organization
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Legal Business Name | MAGNOLIA CARE SERVICES LLC
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 2439 CLUB LAKE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2682
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Country | US
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Telephone | 904-625-7304
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Fax |
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Provider Business Mailing Address
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Address Line | 2439 CLUB LAKE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2682
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Country | US
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Telephone | 904-625-7304
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. SHVADA MAGNOLIA TAYLOR
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Credential | RN
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Telephone | 904-625-7304
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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