Provider Demographics
NPI:1841154465
Name:TALLACARE HEALTH AND WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:TALLACARE HEALTH AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-910-4090
Mailing Address - Street 1:3205 LUCIA WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-3427
Mailing Address - Country:US
Mailing Address - Phone:301-910-4090
Mailing Address - Fax:
Practice Address - Street 1:3205 LUCIA WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-3427
Practice Address - Country:US
Practice Address - Phone:301-910-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty