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General NPI Number Information
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NPI Number | 1568268597
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Entity Type | Organization
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Legal Business Name | MATTHEW 2540 LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 5975 GRAND AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-1369
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Country | US
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Telephone | 951-216-3326
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Fax |
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Provider Business Mailing Address
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Address Line | 20122 DAYTON ST
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City | RIVERSIDE
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State | CA
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Zip | 92508-6301
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Country | US
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Telephone | 951-235-6507
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUITIVE OFFICER
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Name | MR. KEVIN LAWRENCE ANDERSON II
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Credential |
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Telephone | 951-235-6507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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