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General NPI Number Information
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NPI Number | 1699314013
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Entity Type | Organization
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Legal Business Name | MATATA GROUP LLC
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 24707 CAPECASTLE TER
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City | ALDIE
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State | VA
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Zip | 20105-5570
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Country | US
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Telephone | 703-687-2666
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Fax | 703-738-7917
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Provider Business Mailing Address
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Address Line | 24707 CAPECASTLE TER
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City | ALDIE
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State | VA
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Zip | 20105-5570
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Country | US
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Telephone | 703-687-2666
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Fax | 703-738-7917
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. BELINDA AHORNAM GRIFFIN
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Credential |
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Telephone | 703-687-2666
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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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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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