MEDICARE: MAGNOLIA HOME CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194259184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	1307 BUTTERFIELD RD
Second Line	:	SUITE # 416
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5606
Country	:	US
Telephone Number	:	331-903-0693
Fax Number	:	630-206-0693

Provider Business Practice Location Address
First Line	:	1307 BUTTERFIELD RD
Second Line	:	SUITE # 416
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-5606
Country	:	US
Telephone Number	:	331-903-0693
Fax Number	:	630-206-0693

Authorized Official
Title or Position	:	OWNER
Name	:	ABIDEMI FIJABI
Credential	:
Telephone Number	:	331-903-0693

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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