Provider Demographics
NPI:1104543966
Name:MAGIC HOME CARE LLC
Entity type:Organization
Organization Name:MAGIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYAKHIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-622-6760
Mailing Address - Street 1:32910 W 13 MILE RD STE A102C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1980
Mailing Address - Country:US
Mailing Address - Phone:248-256-5054
Mailing Address - Fax:248-430-8886
Practice Address - Street 1:32910 W 13 MILE RD STE A102C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1980
Practice Address - Country:US
Practice Address - Phone:248-256-5054
Practice Address - Fax:248-430-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health