Provider Demographics
NPI:1730485293
Name:GRAHAM, MATTHEW AARON
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:AARON
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SKY MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6013
Mailing Address - Country:US
Mailing Address - Phone:702-326-7953
Mailing Address - Fax:
Practice Address - Street 1:1710 SKY MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6013
Practice Address - Country:US
Practice Address - Phone:702-326-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child