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General NPI Number Information
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NPI Number | 1750817003
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Entity Type | Organization
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Legal Business Name | TAILOR MADE OUTREACH COMPANY LLC
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 301 HIGGINS AVE STE 108
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City | KNOXVILLE
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State | TN
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Zip | 37920-3006
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Country | US
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Telephone | 704-649-4374
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Fax | 865-999-4961
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Provider Business Mailing Address
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Address Line | 4107 HIXSON PIKE SUITE 101
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City | CHATTANOOGA
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State | TN
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Zip | 37415-3130
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Country | US
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Telephone | 704-649-4374
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANAIREA M CAMP
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Credential |
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Telephone | 704-649-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1000000020165
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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