Healthcare Provider Details

I. General information

NPI: 1295193001
Provider Name (Legal Business Name): TRAIL HEAD SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 ELDORADO SPRINGS DR
LOVELAND CO
80538-5321
US

IV. Provider business mailing address

2591 ELDORADO SPRINGS DR
LOVELAND CO
80538-5321
US

V. Phone/Fax

Practice location:
  • Phone: 970-391-6838
  • Fax:
Mailing address:
  • Phone: 970-391-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TOM CLINKENBEARD
Title or Position: OWNER/MANAGER
Credential:
Phone: 970-391-6838