Organization
TAILORED CARE RESIDENCE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAN DIRIE (PRESIDENT)
(651) 352-5050
Entity
Organization
Contact information
Practice address
2311 10TH AVE S, MINNEAPOLIS, MN 55404-3824
(651) 352-5050
Mailing address
2311 10TH AVE S, MINNEAPOLIS, MN 55404-3824
(651) 352-5050
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
12/12/2019
Last updated
12/12/2019
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