Provider Demographics
NPI:1689811945
Name:THE TAILOR INSTITUTE, INC.
Entity Type:Organization
Organization Name:THE TAILOR INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:573-339-9552
Mailing Address - Street 1:3095 LEXINGTON AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2674
Mailing Address - Country:US
Mailing Address - Phone:573-339-9552
Mailing Address - Fax:573-837-1716
Practice Address - Street 1:3095 LEXINGTON AVE STE 500
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2674
Practice Address - Country:US
Practice Address - Phone:573-339-9552
Practice Address - Fax:573-837-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services