Healthcare Provider Details

I. General information

NPI: 1396667648
Provider Name (Legal Business Name): TRAILS END AFC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 TWIN LAKES AVE
LAKE MI
48632-9114
US

IV. Provider business mailing address

5740 TWIN LAKES AVE
LAKE MI
48632-9114
US

V. Phone/Fax

Practice location:
  • Phone: 989-544-3550
  • Fax:
Mailing address:
  • Phone: 989-544-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK DANDRON
Title or Position: LICENSEE DESIGNEE
Credential:
Phone: 989-429-1831