Provider Demographics
NPI:1740827096
Name:MATTHEWS, THERESA KIMBERLY
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KIMBERLY
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43944
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48243-0944
Mailing Address - Country:US
Mailing Address - Phone:321-347-0450
Mailing Address - Fax:
Practice Address - Street 1:3920 RIVARD ST APT 824
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4746
Practice Address - Country:US
Practice Address - Phone:321-347-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No177F00000XOther Service ProvidersLodging
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No282E00000XHospitalsLong Term Care Hospital
No332H00000XSuppliersEyewear Supplier
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion