Provider Demographics
NPI:1861979866
Name:MAGNOLIA SITTERS, LLC
Entity type:Organization
Organization Name:MAGNOLIA SITTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-460-9038
Mailing Address - Street 1:4754 DUBARRY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-4929
Mailing Address - Country:US
Mailing Address - Phone:601-208-0915
Mailing Address - Fax:
Practice Address - Street 1:4754 DUBARRY LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-4929
Practice Address - Country:US
Practice Address - Phone:601-208-0915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care