=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538054945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAILORCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 11TH AVE S STE 300
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-5222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-289-2963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 11TH AVE S STE 300
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-5222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-289-2963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, FP&A
-----------------------------------------------------
Name | BRANDON THALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-289-2963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------