Healthcare Provider Details

I. General information

NPI: 1770726697
Provider Name (Legal Business Name): MATRIX PSYCHIATRIC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 VILLAS ESTATES DR
FENTON MO
63026-3284
US

IV. Provider business mailing address

1423 VILLAS ESTATES DR
FENTON MO
63026-3284
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-5568
  • Fax: 636-825-9568
Mailing address:
  • Phone: 314-954-5568
  • Fax: 636-825-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number132832
License Number StateMO

VIII. Authorized Official

Name: MS. TAMMIE MARIE AUER
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 314-954-5568