MAGNOLIA HOME INC (NPI# 1225528094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225528094 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA HOME INC |
| Practice Address |
918 Sw Idol Ave Port Saint Lucie FL 34953-6728 |
| Practice Telephone | 7726261413 |
| Mailing Telephone | 7726261413 |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2018-05-16 |
| Authorized Official Name | PATRICIA CHRISTIAN (CEO) |
| Authorized Official Telephone | 7726261413 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| Street Address |
918 SW IDOL AVE |
| City | PORT SAINT LUCIE |
| State | FL |
| Zip Code | 34953-6728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733720 | Paul Desantis | Optometrist | 1805 Gatlin Blvd, Port St. Lucie, FL 34953 | 2020-05-29 |
| 1174165997 | D&r Homehealthcare LLC | Technician | 1210 Southwest Santiago Avenue, Port Saint Lucie, Fl, FL 34953 | 2019-10-14 |
| 1023677630 | Physical Therapy Wellness Group | Clinic/Center | 519 Sw Nagle Place, Port Saint Lucie, FL 34953 | 2019-06-07 |
| 1063993699 | Bloom Firm, LLC | Home Health | 1714 Sw Cycle St, Port Saint Lucie, FL 34953 | 2018-08-22 |
| 1386121333 | For His Glory Alf LLC. | Assisted Living Facility | 322 Sw South Quick Circle, Port St Lucie, FL 34953 | 2018-07-23 |
| 1730670555 | Susan May Thyme | Nurse Practitioner | 1762 Sw Choate St, Port Saint Lucie, FL 34953 | 2018-05-29 |
| 1164911301 | Viven Banks | Counselor | 3581 Sw Kromrey St, Port Saint Lucie, FL 34953 | 2018-05-03 |
| 1205323441 | Katherine Monroig | Behavior Technician | 4557 Se Babylon St, Port Saint Lucie, FL 34953 | 2018-04-13 |
| 1528567583 | Roger Rene Trudel | Nurse Practitioner | 3686 Sw Carmody Street, Port St Lucie, FL 34953 | 2018-02-06 |
| 1801315502 | Metushela Nicolas | Adult Companion | 1112 Jennifer Ter, Port Saint Lucie, FL 34953 | 2017-09-13 |
| Find all providers in zip 34953 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395430 | Kettia Noel | Clinic/Center | 1573 Se Clearbrook St, Port Saint Lucie, FL 34983-4050 | 2020-10-30 |
| 1184236911 | Borgeline Marie Jina Vilfort | Clinic/Center | 608 Marsh Isle Cir Apt 305, Port Saint Lucie, FL 34952-1457 | 2020-08-21 |
| 1326657586 | Levan Angella Carter | Clinic/Center | 339 Sw Ridgecrest Dr, Port Saint Lucie, FL 34953-5918 | 2020-07-23 |
| 1437790060 | Goosman Saintil | Clinic/Center | 10497 Sw Tibre Ct, Port Saint Lucie, FL 34987-2347 | 2019-10-04 |
| 1295391605 | House of Grace In Psl | Clinic/Center | 1249 Sw Byron St, Port Saint Lucie, FL 34983-2507 | 2019-05-13 |
| 1124597372 | Grace Place Care Center Inc | Clinic/Center | 160 Se Celestia Ct, Port Saint Lucie, FL 34983-2120 | 2018-11-16 |
| 1851885461 | Nelkim Support Services | Clinic/Center | 271 Sw Aubudon Ave, Port Saint Lucie, FL 34984-5029 | 2018-06-18 |
| 1326532029 | Chambers Enterprises Servicing Inc | Clinic/Center | 839 Nw Greenwich Ct, Port Saint Lucie, FL 34983-3403 | 2018-06-18 |
| 1497262679 | Donna Shipes | Clinic/Center | 1834 Se Mandrake Cir, Port Saint Lucie, FL 34952-6945 | 2018-01-09 |
| 1003322132 | Joy Blakeslee | Clinic/Center | 3100 Columbrina Cir, Port Saint Lucie, FL 34952-3334 | 2017-12-27 |
| Find all providers in PORT SAINT LUCIE | ||||
| City | PORT SAINT LUCIE |
| Zip Code | 34953 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.