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General NPI Number Information
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NPI Number | 1578249710
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 7927 IRONWOOD DR
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4406
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Country | US
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Telephone | 901-212-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 7927 IRONWOOD DR
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4406
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Country | US
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Telephone | 901-212-1469
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KIMBERLY LASHAY WARD
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Credential |
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Telephone | 901-212-1469
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 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 #4
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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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