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General NPI Number Information
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NPI Number | 1851017784
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Entity Type | Organization
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Legal Business Name | MATRIX LIFECARE CENTER INC.
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 938 MEZZANINE DR STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-8641
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Country | US
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Telephone | 765-742-1533
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Fax | 765-742-1824
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Provider Business Mailing Address
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Address Line | 938 MEZZANINE DR STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-8641
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Country | US
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Telephone | 765-742-1533
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Fax | 765-742-1824
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | JONNI MILLER
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Credential | RN
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Telephone | 765-742-1533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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