Provider Demographics
NPI:1255495214
Name:MATRIA HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MATRIA HEALTHCARE, INC.
Other - Org Name:CORSOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-767-4600
Mailing Address - Street 1:1850 PARKWAY PL SE
Mailing Address - Street 2:ATTN REIMBURSEMENT
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4439
Mailing Address - Country:US
Mailing Address - Phone:770-767-4999
Mailing Address - Fax:770-767-7420
Practice Address - Street 1:1850 PARKWAY PL SE
Practice Address - Street 2:ATTN REIMBURSEMENT
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4439
Practice Address - Country:US
Practice Address - Phone:770-767-4999
Practice Address - Fax:770-767-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000Q00005OtherBC BS OF MI PROVIDER NUM.
OH=========002OtherMMO PROVIDER NUMBER
MI71020000Q00005OtherBC BS OF MI PROVIDER NUM.
MI71020000Q00005OtherBC BS OF MI PROVIDER NUM.
CACCDP00009Medicare PIN