MEDICARE: MATURE MATTERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MI

General Provider Information

NPI Number	:	1891796033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATURE MATTERS, LLC

Provider Business Mailing Address
First Line	:	18927 DEQUINDRE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1205
Country	:	US
Telephone Number	:	313-610-5830
Fax Number	:	313-592-1530

Provider Business Practice Location Address
First Line	:	18927 DEQUINDRE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1205
Country	:	US
Telephone Number	:	313-610-5830
Fax Number	:	313-592-1530

Authorized Official
Title or Position	:	COO
Name	:	MS. BETTY J INGRAM
Credential	:	RN
Telephone Number	:	313-610-5830

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	11/13/2014

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