Provider Demographics
NPI:1699053413
Name:MATRIX PSYCHIATRIC HOME CARE
Entity type:Organization
Organization Name:MATRIX PSYCHIATRIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AUER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:314-954-5568
Mailing Address - Street 1:5026 E CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1821
Mailing Address - Country:US
Mailing Address - Phone:314-954-5568
Mailing Address - Fax:314-487-2447
Practice Address - Street 1:5026 E CONCORD RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1821
Practice Address - Country:US
Practice Address - Phone:314-954-5568
Practice Address - Fax:314-487-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132832364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty