Provider Demographics
NPI:1649769779
Name:TAILORED IN-HOME CARE AND ASSISTANCE
Entity Type:Organization
Organization Name:TAILORED IN-HOME CARE AND ASSISTANCE
Other - Org Name:TAILORED IN-HOME CARE AND ASSISTANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OTELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-964-5436
Mailing Address - Street 1:1022 INDIAN TRAIL LILBURN RD NW STE C
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6891
Mailing Address - Country:US
Mailing Address - Phone:678-964-5436
Mailing Address - Fax:678-573-6560
Practice Address - Street 1:1022 INDIAN TRAIL LILBURN RD NW STE C
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6891
Practice Address - Country:US
Practice Address - Phone:678-964-5436
Practice Address - Fax:678-573-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX