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General NPI Number Information
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NPI Number | 1477172815
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HOME HEALTHCARE
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 971 OAKMONT PL APT 2
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City | MEMPHIS
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State | TN
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Zip | 38107-3210
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Country | US
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Telephone | 901-503-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 971 OAKMONT PL APT 2
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City | MEMPHIS
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State | TN
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Zip | 38107-3210
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Country | US
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Telephone | 901-503-4036
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAKIESHA LASHA MOORE
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Credential |
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Telephone | 901-503-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care 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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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