Provider Demographics
NPI:1720413834
Name:TAYLORMADE LIFE RESOURCES
Entity type:Organization
Organization Name:TAYLORMADE LIFE RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-550-9095
Mailing Address - Street 1:1200 W WALNUT HILL LN
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3029
Mailing Address - Country:US
Mailing Address - Phone:972-550-9095
Mailing Address - Fax:866-463-3678
Practice Address - Street 1:1200 W WALNUT HILL LN
Practice Address - Street 2:SUITE 3000
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3029
Practice Address - Country:US
Practice Address - Phone:972-550-9095
Practice Address - Fax:866-463-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable