MEDICARE: GRAY MATTERS ALLIANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1477112092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAY MATTERS ALLIANCE LLC

Provider Business Mailing Address
First Line	:	119 S MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2802
Country	:	US
Telephone Number	:	314-266-2678
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 S MAIN ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2802
Country	:	US
Telephone Number	:	314-322-3875
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKI SPRAUL
Credential	:
Telephone Number	:	314-266-2678

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	04/24/2024

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