# MAGNIFICENT CARING HOME HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740894013
- **Authorized official:** MRS. TAMICKA NELSON-BOBO (OWNER/ DIRECTOR)
- **Authorized official phone:** (314) 629-7281

## Contact information

- **Practice address:** 12215 WINTERSET DR, BLACK JACK, MO 63033-7333
- **Practice address phone:** (314) 629-7281
- **Practice address fax:** (314) 699-4648
- **Mailing address:** 12215 WINTERSET DR, BLACK JACK, MO 63033-7333
- **Mailing address phone:** (314) 629-7281
- **Mailing address fax:** (314) 699-4648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 132700000X | Dietary Manager | — | NULL | — |
| 132700000X | Dietary Manager | — | — | — |
| 174200000X | Meals Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 09/03/2020
- **Last updated:** 09/02/2022