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General NPI Number Information
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NPI Number | 1558908723
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Entity Type | Organization
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Legal Business Name | MAGNIFICENT HOMECARE LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 182 RILEY AVE STE F2
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City | MACON
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State | GA
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Zip | 31204-0778
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Country | US
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Telephone | 478-318-8799
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3831
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City | MACON
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State | GA
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Zip | 31205-3831
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Country | US
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Telephone | 478-318-8799
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHAQUAZLYN GRANADA GEORGE
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Credential |
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Telephone | 478-318-8799
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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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