MEDICARE: THE TAILOR INSTITUTE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		MO
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1689811945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TAILOR INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	3095 LEXINGTON AVE STE 500
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2674
Country	:	US
Telephone Number	:	573-339-9552
Fax Number	:	573-837-1716

Provider Business Practice Location Address
First Line	:	3095 LEXINGTON AVE STE 500
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2674
Country	:	US
Telephone Number	:	573-339-9552
Fax Number	:	573-837-1716

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CARISSA ANNE TRACY
Credential	:	BA
Telephone Number	:	573-339-9552

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	12/04/2018

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