Provider Demographics
NPI:1124679618
Name:TAILORED SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:TAILORED SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANEEN
Authorized Official - Middle Name:DEDEKOSI
Authorized Official - Last Name:DICLER-ANKAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-650-7405
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-0648
Mailing Address - Country:US
Mailing Address - Phone:484-784-7702
Mailing Address - Fax:
Practice Address - Street 1:1123 N 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3209
Practice Address - Country:US
Practice Address - Phone:484-948-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health