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General NPI Number Information
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NPI Number | 1821325176
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Entity Type | Organization
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Legal Business Name | MATRIX HUMAN SERVICES
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 450 ELIOT
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City | DETROIT
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State | MI
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Zip | 48201-2130
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Country | US
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Telephone | 313-831-8650
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Fax | 313-831-3611
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Provider Business Mailing Address
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Address Line | 120 PARSONS STREET
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City | DETROIT
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State | MI
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Zip | 48201-2002
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Country | US
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Telephone | 313-831-1000
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Fax | 313-831-4634
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. BRAD COULTURE
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Credential |
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Telephone | 313-831-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | MI
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