Provider Demographics
NPI:1760931653
Name:QUADRI BEHAVIORAL LLC
Entity Type:Organization
Organization Name:QUADRI BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-222-5882
Mailing Address - Street 1:9890 CLAYTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-222-5882
Mailing Address - Fax:314-222-5883
Practice Address - Street 1:9890 CLAYTON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-222-5882
Practice Address - Fax:314-222-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1014352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811071665Medicaid
MO101435OtherLICENSE MEDICAL
MO1811071665OtherINDIVIDUAL NPI
MO000050162OtherMEDICARE PTAN
MO071540162OtherMEDICARE INDIVI PTAN
MO24211OtherCDS/BNDD
MO24211OtherCDS/BNDD