Provider Demographics
NPI:1659700219
Name:MATGLOCO MINISRIES
Entity Type:Organization
Organization Name:MATGLOCO MINISRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-400-4456
Mailing Address - Street 1:24609 S LAKEVIEW CT
Mailing Address - Street 2:APT 202
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2457
Mailing Address - Country:US
Mailing Address - Phone:313-400-4456
Mailing Address - Fax:
Practice Address - Street 1:24609 S LAKEVIEW CT
Practice Address - Street 2:APT 202
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2457
Practice Address - Country:US
Practice Address - Phone:313-400-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68076557253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care