Magnolia Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

MAGNOLIA HOSPICE, LLC

Doing business as

OpusCare of Georgia

Practice address

1374 Manchester Dr NE
Conyers, GA 30012-3881

Phone

(770) 483-9111

Fax

(877) 663-8423

NPI assigned

Feb 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ismael Roque-Velasco

Title

President/Ceo

Phone

(305) 591-1606

Specialties & licenses 1

Addresses

Other names 1

• OpusCare of Georgia Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 111754

Legal name

MAGNOLIA HOSPICE, LLC

Doing business as

OPUSCARE OF GEORGIA

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 2, 2014

Last certification

Aug 21, 2019

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Nov 7, 2013 in GA

Enrollment address

5040 Snapfinger Woods Dr
Ste 204a
Stonecrest, GA 30035-4020

Listed as

Opuscare of GeorgiaCCN 111754 · All quality measures

Ownership

For-Profit

Certified

Oct 2, 2014

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Miguel E Stubbs, M.D.,P.C.

  • Internal Medicine Physician
  • Smyrna, GA
  • NPI 1477591675

  Contracted Managing Employee

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• My Own Hospice LLC

  dba OpusCare of Texas

  • Community Based Hospice Care Agency
  • San Antonio, TX
  • NPI 1558772905

  Opus Care Management LLC, Opuscare Holdings LLC, Roque Opus 13 Holdings LLC, Tenderseas, Inc.

  CMS ownership
• Opuscare of Florida LLC

  • Community Based Hospice Care Agency
  • Miami, FL
  • NPI 1033753793

  Opus Care Management LLC, Opuscare Holdings LLC, Roque Opus 13 Holdings LLC

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Sherika Surata Newman, D.O.

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Atlanta, GA
  • NPI 1740442599
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684281600000",
    "number": "1396169074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 SW 80TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331434931",
            "telephone_number": "305-591-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1374 MANCHESTER DR NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123881",
            "telephone_number": "770-483-9111",
            "fax_number": "877-663-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "ROQUE-VELASCO",
        "authorized_official_first_name": "ISMAEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "305-591-1606"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OpusCare of Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Enricka Victoria Maddox, LPC
• Magan Maddox, LPN
• Janette Madry-Bower
• Madu Medical Group, P.C.
• Magnolia Ambulance Service
• Mariny Margaret Mahabee-Harris, PH.D.
• Ritika Mahajan, M.D.
• Rajendra Maharaj, NP
• Casey Maher
• William Bernard Mahoney, M.D.

• Community Based Hospice Care Agency in Conyers, GA
• Providers in Conyers, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.