Provider Demographics
NPI:1952095036
Name:MATA RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:MATA RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:NTARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-408-2792
Mailing Address - Street 1:8805 W GLENN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6903
Mailing Address - Country:US
Mailing Address - Phone:207-408-2792
Mailing Address - Fax:
Practice Address - Street 1:8805 W GLENN DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-6903
Practice Address - Country:US
Practice Address - Phone:207-408-2792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATA RESIDENTIAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities