Healthcare Provider Details

I. General information

NPI: 1215717673
Provider Name (Legal Business Name): TAILORED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 EMERSON WAY STE 130
INDIANAPOLIS IN
46226-1466
US

IV. Provider business mailing address

10916 VEON DR
FISHERS IN
46038-9392
US

V. Phone/Fax

Practice location:
  • Phone: 317-362-0293
  • Fax: 317-744-9556
Mailing address:
  • Phone: 317-488-8334
  • Fax: 317-744-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAQUITA T TAYLOR
Title or Position: OWNER
Credential: FNP-C
Phone: 317-488-8334