=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104628551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAILORED CARE HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5435 EMERSON WAY STE 130
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46226-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-879-5268
-----------------------------------------------------
Fax | 317-744-9556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5435 EMERSON WAY STE 130
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46226-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-879-5268
-----------------------------------------------------
Fax | 317-744-9556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAQUITA T TAYLOR
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 317-879-5268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------