Provider Demographics
NPI:1376651489
Name:MATRIX LLC
Entity Type:Organization
Organization Name:MATRIX LLC
Other - Org Name:METRON SUB ACUTE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SUB ACUTE SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEJA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-957-3957
Mailing Address - Street 1:3075 ORCHARD VISTA DR SE
Mailing Address - Street 2:STE. 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 MOMENTUM PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60689-5316
Practice Address - Country:US
Practice Address - Phone:616-975-5209
Practice Address - Fax:616-588-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility