Provider Demographics
NPI:1225344542
Name:TAI VENTURES
Entity Type:Organization
Organization Name:TAI VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI-AWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-400-2000
Mailing Address - Street 1:5160 FINNHORSE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2562
Mailing Address - Country:US
Mailing Address - Phone:214-400-2000
Mailing Address - Fax:214-235-0438
Practice Address - Street 1:5160 FINNHORSE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2562
Practice Address - Country:US
Practice Address - Phone:972-763-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01416326OtherAMERIGROUP