MEDICARE: MRS. DENITA MATOS

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	372500000X	Chore Provider
2	372600000X	Adult Companion
3	373H00000X	Day Training/Habilitation Specialist
4	374U00000X	Home Health Aide
5	376J00000X	Homemaker	321422540804	OH
6	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1437566684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENITA MATOS

Provider Business Mailing Address
First Line	:	18129 PONCIANA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3903
Country	:	US
Telephone Number	:	216-778-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	18129 PONCIANA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3903
Country	:	US
Telephone Number	:	216-778-9577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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