Provider Demographics
NPI:1851017784
Name:MATRIX LIFECARE CENTER INC.
Entity Type:Organization
Organization Name:MATRIX LIFECARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-742-1533
Mailing Address - Street 1:938 MEZZANINE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8641
Mailing Address - Country:US
Mailing Address - Phone:765-742-1533
Mailing Address - Fax:765-742-1824
Practice Address - Street 1:938 MEZZANINE DR STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8641
Practice Address - Country:US
Practice Address - Phone:765-742-1533
Practice Address - Fax:765-742-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty