Healthcare Provider Details

I. General information

NPI: 1710851415
Provider Name (Legal Business Name): TRAOSHI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7738 WYKES ST
DETROIT MI
48210-1026
US

IV. Provider business mailing address

20049 EVERGREEN MEADOWS RD
SOUTHFIELD MI
48076-4214
US

V. Phone/Fax

Practice location:
  • Phone: 248-469-5570
  • Fax:
Mailing address:
  • Phone: 248-469-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TRACEY TATE
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 248-469-5570