Provider Demographics
NPI:1568268597
Name:MATTHEW 2540 LLC
Entity type:Organization
Organization Name:MATTHEW 2540 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUITIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:951-235-6507
Mailing Address - Street 1:20122 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6301
Mailing Address - Country:US
Mailing Address - Phone:951-235-6507
Mailing Address - Fax:
Practice Address - Street 1:5975 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1369
Practice Address - Country:US
Practice Address - Phone:951-216-3326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging