MEDICARE: MAGNIFICENT CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1750217493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNIFICENT CARE LLC

Provider Business Mailing Address
First Line	:	5933 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4952
Country	:	US
Telephone Number	:	314-583-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	5933 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4952
Country	:	US
Telephone Number	:	314-583-9443
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ANTWONE MOORE JR.
Credential	:
Telephone Number	:	314-583-9443

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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