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General NPI Number Information
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NPI Number | 1336921535
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Entity Type | Organization
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Legal Business Name | TAILORED-MADE HEALTHCARE
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 7315 FREE AVE
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-5429
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Country | US
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Telephone | 216-647-1503
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Fax |
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Provider Business Mailing Address
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Address Line | 7315 FREE AVE
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-5429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR (OWNER)
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Name | TAILOR PERRY
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Credential |
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Telephone | 216-647-1503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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