Provider Demographics
NPI:1043909567
Name:THE TAILYN FOUNDATION LLC
Entity Type:Organization
Organization Name:THE TAILYN FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-307-6441
Mailing Address - Street 1:9901 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5803
Mailing Address - Country:US
Mailing Address - Phone:512-243-6913
Mailing Address - Fax:
Practice Address - Street 1:11611 ELK PARK TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7875
Practice Address - Country:US
Practice Address - Phone:251-307-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)