Healthcare Provider Details

I. General information

NPI: 1104683879
Provider Name (Legal Business Name): MATTHEWS HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10056 ROTHGARD RD
SPRING VALLEY CA
91977
US

IV. Provider business mailing address

10056 ROTHGARD RD
SPRING VALLEY CA
91977
US

V. Phone/Fax

Practice location:
  • Phone: 858-262-3057
  • Fax:
Mailing address:
  • Phone: 858-262-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS EVA MASONER
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 858-262-3057