Provider Demographics
NPI:1265755037
Name:MATRIX PSYCHIATRIC HOME AND HEALTH CARE, L.L.C.
Entity type:Organization
Organization Name:MATRIX PSYCHIATRIC HOME AND HEALTH CARE, L.L.C.
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
Authorized Official - Phone:314-954-5568
Mailing Address - Street 1:1423 VILLAS ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3284
Mailing Address - Country:US
Mailing Address - Phone:314-954-5568
Mailing Address - Fax:
Practice Address - Street 1:1423 VILLAS ESTATES DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3284
Practice Address - Country:US
Practice Address - Phone:314-954-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132832251K00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty