Provider Demographics
NPI:1356989164
Name:TAILORED CARE RESIDENCE, INC
Entity type:Organization
Organization Name:TAILORED CARE RESIDENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-352-5050
Mailing Address - Street 1:2311 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3824
Mailing Address - Country:US
Mailing Address - Phone:651-352-5050
Mailing Address - Fax:
Practice Address - Street 1:2311 10TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3824
Practice Address - Country:US
Practice Address - Phone:651-352-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances