MEDICARE: MATRIX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		MI

General Provider Information

NPI Number	:	1376651489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX LLC

Provider Business Mailing Address
First Line	:	3075 ORCHARD VISTA DR SE
Second Line	:	STE. 100
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 MOMENTUM PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5316
Country	:	US
Telephone Number	:	616-975-5209
Fax Number	:	616-588-0971

Authorized Official
Title or Position	:	DIRECTOR OF SUB ACUTE SERVICES
Name	:	MRS. DIANNE MATEJA
Credential	:	RN
Telephone Number	:	616-957-3957

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/21/2022

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Directions to “MATRIX LLC ” Practice Location

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