Healthcare Provider Details

I. General information

NPI: 1699053413
Provider Name (Legal Business Name): MATRIX PSYCHIATRIC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5026 E CONCORD RD
SAINT LOUIS MO
63128-1821
US

IV. Provider business mailing address

5026 E CONCORD RD
SAINT LOUIS MO
63128-1821
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-5568
  • Fax: 314-487-2447
Mailing address:
  • Phone: 314-954-5568
  • Fax: 314-487-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number132832
License Number StateMO

VIII. Authorized Official

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