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General NPI Number Information
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NPI Number | 1124679618
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Entity Type | Organization
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Legal Business Name | TAILORED SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1123 N 63RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19151-3209
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Country | US
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Telephone | 484-948-5213
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 648
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City | DARBY
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State | PA
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Zip | 19023-0648
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Country | US
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Telephone | 484-784-7702
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. DANEEN DEDEKOSI DICLER-ANKAMAH
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Credential |
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Telephone | 215-650-7405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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