Provider Demographics
NPI:1194259184
Name:MAGNOLIA HOME CARE SERVICES
Entity type:Organization
Organization Name:MAGNOLIA HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIDEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIJABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-903-0693
Mailing Address - Street 1:1307 BUTTERFIELD RD
Mailing Address - Street 2:SUITE # 416
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5606
Mailing Address - Country:US
Mailing Address - Phone:331-903-0693
Mailing Address - Fax:630-206-0693
Practice Address - Street 1:1307 BUTTERFIELD RD
Practice Address - Street 2:SUITE # 416
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5606
Practice Address - Country:US
Practice Address - Phone:331-903-0693
Practice Address - Fax:630-206-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care