Provider Demographics
NPI:1821325176
Name:MATRIX HUMAN SERVICES
Entity Type:Organization
Organization Name:MATRIX HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:COULTURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-831-1000
Mailing Address - Street 1:120 PARSONS STREET
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2002
Mailing Address - Country:US
Mailing Address - Phone:313-831-1000
Mailing Address - Fax:313-831-4634
Practice Address - Street 1:450 ELIOT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2130
Practice Address - Country:US
Practice Address - Phone:313-831-8650
Practice Address - Fax:313-831-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty