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General NPI Number Information
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NPI Number | 1548671076
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Entity Type | Organization
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Legal Business Name | TAILORED GROUP LLC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 4726 MAPLE CREEK DR
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City | FRESNO
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State | TX
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Zip | 77545-6066
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Country | US
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Telephone | 832-882-9053
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Fax | 281-972-9551
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Provider Business Mailing Address
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Address Line | 4726 MAPLE CREEK DR
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City | FRESNO
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State | TX
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Zip | 77545-6066
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Country | US
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Telephone | 832-882-9053
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Fax | 281-972-9551
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Authorized Official
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Title or Position | OWNER
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Name | GLORIA DAVIS
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Credential |
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Telephone | 832-882-9053
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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 | TX
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