Provider Demographics
NPI:1093498602
Name:MATHAS HOUSE LLC
Entity Type:Organization
Organization Name:MATHAS HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMES
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:323-381-0025
Mailing Address - Street 1:13622 CHADRON AVE APT 40
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-9251
Mailing Address - Country:US
Mailing Address - Phone:323-381-0025
Mailing Address - Fax:
Practice Address - Street 1:2422 E 113TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2112
Practice Address - Country:US
Practice Address - Phone:323-381-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility