Provider Demographics
NPI:1588241467
Name:TAYLORED LIFE CARE
Entity type:Organization
Organization Name:TAYLORED LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHOCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:304-893-7000
Mailing Address - Street 1:806 NEAL ST UNIT 3589
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26103-4032
Mailing Address - Country:US
Mailing Address - Phone:304-916-2593
Mailing Address - Fax:
Practice Address - Street 1:747 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-916-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLORED LIFE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679706469OtherNPI