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General NPI Number Information
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NPI Number | 1154856516
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Entity Type | Organization
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Legal Business Name | MATRIX ADVOCARE NETWORK, INC.
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 7550 FRANCE AVE S SUITE 210
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City | EDINA
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State | MN
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Zip | 55435-5624
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Country | US
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Telephone | 952-525-0505
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Fax | 952-525-0506
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Provider Business Mailing Address
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Address Line | 7550 FRANCE AVE S SUITE 210
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City | EDINA
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State | MN
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Zip | 55435-5624
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Country | US
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Telephone | 952-525-0505
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Fax | 952-525-0506
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. BRUCE JAMES LAWRENCE
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Credential |
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Telephone | 952-525-0505
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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 | 376580
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License Number State | MN
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