Provider Demographics
NPI:1073108163
Name:NGATI, MATHIEW (DBA)
Entity type:Individual
Prefix:
First Name:MATHIEW
Middle Name:
Last Name:NGATI
Suffix:
Gender:M
Credentials:DBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5539
Mailing Address - Country:US
Mailing Address - Phone:301-605-2799
Mailing Address - Fax:
Practice Address - Street 1:507 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5539
Practice Address - Country:US
Practice Address - Phone:301-605-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000642163WH0200X, 374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide