Provider Demographics
NPI:1902937303
Name:MATISSE INVESTMENT GROUP, LLC
Entity Type:Organization
Organization Name:MATISSE INVESTMENT GROUP, LLC
Other - Org Name:CIRCO PEDIATRIC REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-994-9501
Mailing Address - Street 1:2010 S CYNTHIA ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1386
Mailing Address - Country:US
Mailing Address - Phone:956-994-9501
Mailing Address - Fax:
Practice Address - Street 1:2010 S CYNTHIA ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1386
Practice Address - Country:US
Practice Address - Phone:956-994-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172728101Medicaid
TX172728101Medicaid