Organization
TAILOR MADE OUTREACH COMPANY LLC
Active
Parent organization
TAILOR MADE OUTREACH COMPANY LLC
Other names
Miracle Healthcare Providers
Organization subpart
Yes
Provider details
NPI number
Legal business name
TAILOR MADE OUTREACH COMPANY LLC
Authorized official
SHANAIREA M CAMP (CEO)
(704) 649-4374
Entity
Organization
Contact information
Practice address
301 HIGGINS AVE STE 108, KNOXVILLE, TN 37920-3006
(704) 649-4374
(865) 999-4961
Mailing address
4107 HIXSON PIKE, SUITE 101, CHATTANOOGA, TN 37415-3130
(704) 649-4374
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
1000000020165
TN
261QR0400X
Rehabilitation Clinic/Center
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q031164
—
TN
Enumeration date
05/05/2017
Last updated
07/21/2022
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