MEDICARE: TIGER PLACE, LLC

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	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1821044132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIGER PLACE, LLC

Provider Business Mailing Address
First Line	:	3003 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-256-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-256-4620
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	KYLE SCHADE
Credential	:
Telephone Number	:	573-471-1113

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	11/29/2022

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