MATTHEW R CARLSON Nursing Home Administrator License verification

Business Entity

NOT RENEWED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044010775

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

Last Name

CARLSON

Business Name

MATTHEW R CARLSON

Original Issue Date

10/19/2011

Effective Date

12/01/2021

Expiration Date

11/30/2023

City

FORT WAYNE

State

Zip

46818

County

INDIANA

Specialty/Qualifier

NON LIMITED

Ever Disciplined

LastModifiedDate

04/16/2024