Provider Demographics
NPI:1699314013
Name:MATATA GROUP LLC
Entity type:Organization
Organization Name:MATATA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:AHORNAM
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-687-2666
Mailing Address - Street 1:24707 CAPECASTLE TER
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5570
Mailing Address - Country:US
Mailing Address - Phone:703-687-2666
Mailing Address - Fax:703-738-7917
Practice Address - Street 1:24707 CAPECASTLE TER
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5570
Practice Address - Country:US
Practice Address - Phone:703-687-2666
Practice Address - Fax:703-738-7917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347E00000XTransportation ServicesTransportation Broker