Provider Demographics
NPI:1477315497
Name:MATODA INC
Entity Type:Organization
Organization Name:MATODA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNDIWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-349-3076
Mailing Address - Street 1:6821 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1951
Mailing Address - Country:US
Mailing Address - Phone:559-349-3076
Mailing Address - Fax:
Practice Address - Street 1:6821 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1951
Practice Address - Country:US
Practice Address - Phone:559-349-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility