MEDICARE: MAGNIFICENT TOUCH SERVICES LLC

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	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1548890767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNIFICENT TOUCH SERVICES LLC

Provider Business Mailing Address
First Line	:	4224 CHIPPENDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3604
Country	:	US
Telephone Number	:	267-240-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 CHIPPENDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3604
Country	:	US
Telephone Number	:	267-240-4258
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHONDA VAUGHN
Credential	:
Telephone Number	:	267-240-4258

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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