Healthcare Provider Details

I. General information

NPI: 1821325176
Provider Name (Legal Business Name): MATRIX HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ELIOT
DETROIT MI
48201-2130
US

IV. Provider business mailing address

120 PARSONS STREET
DETROIT MI
48201-2002
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-8650
  • Fax: 313-831-3611
Mailing address:
  • Phone: 313-831-1000
  • Fax: 313-831-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. BRAD COULTURE
Title or Position: C.E.O.
Credential:
Phone: 313-831-1000