MEDICARE: MAGNOLIA CARE HOSPICE, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1831904382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA CARE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD STE 1040B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5855
Country	:	US
Telephone Number	:	702-793-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD STE 1040B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5855
Country	:	US
Telephone Number	:	702-793-0182
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	ANDREW FERNANDO
Credential	:
Telephone Number	:	702-497-1338

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	03/10/2026

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