| Doctor Name: | STACEY MATTOCKS |
| NPI Number: | 1144639899 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AL12547 |
| Business Practice Address: | 6839 Nw 15th St Plantation, FL - 333135318 |
| Business Phone Number: | 9543173979 |
| Business Fax Number: | 9543173331 |
| Mailing Address: | 6839 Nw 15th St, PLANTATION |
| State: | FL |
| Postal Code: | 333135318 |
| Phone Number: | 9543173979 |
| Fax Number: | 9543173331 |
| NPI Enumeration Date: | 08/07/2014 |
| NPI Last Update Date: | 08/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | AL12547 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |