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General NPI Number Information
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NPI Number | 1013503739
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Entity Type | Organization
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Legal Business Name | MATISA INC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 601 PALM DR APT 102
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City | GLENDALE
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State | CA
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Zip | 91202-3311
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Country | US
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Telephone | 818-391-0634
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Fax |
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Provider Business Mailing Address
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Address Line | 601 PALM DR APT 102
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City | GLENDALE
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State | CA
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Zip | 91202-3311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | JADE HANSON
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Credential |
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Telephone | 916-934-4913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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