Provider Demographics
NPI:1801387808
Name:MATRIXX HEALTHCARE LLC
Entity Type:Organization
Organization Name:MATRIXX HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-756-4422
Mailing Address - Street 1:522 S INDEPENDENCE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1149
Mailing Address - Country:US
Mailing Address - Phone:757-756-4222
Mailing Address - Fax:757-756-4423
Practice Address - Street 1:522 S INDEPENDENCE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23452-1149
Practice Address - Country:US
Practice Address - Phone:757-756-4222
Practice Address - Fax:757-756-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
332B00000X, 332BN1400X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No385H00000XRespite Care FacilityRespite Care