Provider Demographics
NPI:1023208196
Name:TAILORED CARE INC
Entity Type:Organization
Organization Name:TAILORED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-368-1512
Mailing Address - Street 1:1405 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3809
Mailing Address - Country:US
Mailing Address - Phone:504-368-6483
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BLDG 5 STE 1
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-368-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 8682251C00000X
LASIL 8683251C00000X
LARC 8681251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1472107Medicaid
LA1435597Medicaid
LA1435619Medicaid