Provider Demographics
NPI:1104375013
Name:MATTMO OUTREACH RESIDENTIAL SERIVCES
Entity Type:Organization
Organization Name:MATTMO OUTREACH RESIDENTIAL SERIVCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:HAJAH
Authorized Official - Middle Name:MEMUNATU
Authorized Official - Last Name:CONTEH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:804-912-4095
Mailing Address - Street 1:135 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2568
Mailing Address - Country:US
Mailing Address - Phone:804-912-4095
Mailing Address - Fax:
Practice Address - Street 1:135 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2568
Practice Address - Country:US
Practice Address - Phone:804-912-4095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness