MEDICARE: MAGNOLIA'S HEART INCORPORATED 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1720423023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA'S HEART INCORPORATED LLC

Provider Business Mailing Address
First Line	:	PO BOX 46212
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-6212
Country	:	US
Telephone Number	:	702-201-1657
Fax Number	:	702-921-3333

Provider Business Practice Location Address
First Line	:	4550 W OAKEY BLVD STE 111M
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1581
Country	:	US
Telephone Number	:	702-201-1657
Fax Number	:	702-921-3333

Authorized Official
Title or Position	:	CEO
Name	:	LISA MOFFETT
Credential	:	LCSW
Telephone Number	:	702-201-1657

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	04/19/2020

Similar Medicare Providers

1023125325 — DR. DAVID LEE HOPPER PHD
Practice Location Address:

4550 W OAKEY BLVD , SUITE # 106
LAS VEGAS, NV
89102-1581

Practice Phone: 702-405-6644
Practice Fax: 702-586-2057

1073899779 — MS. PAMELA MARIE WILSON
Practice Location Address:

4550 W OAKEY BLVD , SUIT 100
LAS VEGAS, NV
89102-1581

Practice Phone: 702-726-6122
Practice Fax:

1841542339 — WHOLE LIFE HEALTH THERAPY AND WELLNESS CENTER
Practice Location Address:

4550 W OAKEY BLVD , STE 99A
LAS VEGAS, NV
89102-1581

Practice Phone: 702-321-6222
Practice Fax:

1649516980 — EILEEN CASTLE
Practice Location Address:

4550 W OAKEY BLVD
LAS VEGAS, NV
89102-1581

Practice Phone: 702-371-9838
Practice Fax: 702-586-2057

1588902167 — MOTIVATION 4 CHANGE FAMILY SERVICES
Practice Location Address:

4550 W OAKEY BLVD , STE 97
LAS VEGAS, NV
89102-1581

Practice Phone: 702-719-9074
Practice Fax:

1205276334 — MR. ALEJANDRO GUZMAN SR.
Practice Location Address:

4550 W OAKEY BLVD , SUITE 111-Q
LAS VEGAS, NV
89102-1581

Practice Phone: 702-968-9372
Practice Fax: 702-932-3189

Directions to “MAGNOLIA'S HEART INCORPORATED LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.