Provider Demographics
NPI:1407283666
Name:MATUSIK ADULT FAMILY CARE HOME
Entity Type:Organization
Organization Name:MATUSIK ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:HANSRAJDAI
Authorized Official - Last Name:MATUSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-774-6493
Mailing Address - Street 1:1580 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8723
Mailing Address - Country:US
Mailing Address - Phone:386-774-6493
Mailing Address - Fax:386-774-6493
Practice Address - Street 1:1580 PETERSON RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8723
Practice Address - Country:US
Practice Address - Phone:386-774-6493
Practice Address - Fax:386-774-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906460171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty