Provider Demographics
NPI:1720669989
Name:MAGNIFICENT HEALTHCARE & CPR INC.
Entity type:Organization
Organization Name:MAGNIFICENT HEALTHCARE & CPR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:OKODUA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, RN
Authorized Official - Phone:773-856-3202
Mailing Address - Street 1:6443 N HOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5850
Mailing Address - Country:US
Mailing Address - Phone:312-685-5243
Mailing Address - Fax:
Practice Address - Street 1:2046 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2241
Practice Address - Country:US
Practice Address - Phone:312-685-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20210108206845Medicaid