Provider Demographics
NPI:1700223286
Name:TARA MAHANEY, LLC
Entity Type:Organization
Organization Name:TARA MAHANEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-282-2281
Mailing Address - Street 1:7261 PEBBLE PL
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9126
Mailing Address - Country:US
Mailing Address - Phone:517-282-2281
Mailing Address - Fax:
Practice Address - Street 1:526 S CREYTS RD
Practice Address - Street 2:SUITE E
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8263
Practice Address - Country:US
Practice Address - Phone:517-282-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech