Individual
STACEY MATTOCKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6839 NW 15TH ST, PLANTATION, FL 33313-5318
(954) 317-3979
(954) 317-3331
Mailing address
6839 NW 15TH ST, PLANTATION, FL 33313-5318
(954) 317-3979
(954) 317-3331
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12547
FL
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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