Provider Demographics
NPI:1720105323
Name:MAGNA HEALTH CARE INC
Entity type:Organization
Organization Name:MAGNA HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-459-5074
Mailing Address - Street 1:4271 W ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1233
Mailing Address - Country:US
Mailing Address - Phone:918-459-5074
Mailing Address - Fax:918-459-5075
Practice Address - Street 1:4271 W ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1233
Practice Address - Country:US
Practice Address - Phone:918-459-5074
Practice Address - Fax:918-459-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10064480GMedicaid