Healthcare Provider Details

I. General information

NPI: 1295354637
Provider Name (Legal Business Name): T.R.A.I.L. CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 BARLOW ST
TRAVERSE CITY MI
49686-4250
US

IV. Provider business mailing address

935 BARLOW ST
TRAVERSE CITY MI
49686-4250
US

V. Phone/Fax

Practice location:
  • Phone: 231-932-9030
  • Fax: 231-941-3421
Mailing address:
  • Phone: 231-932-9030
  • Fax: 231-941-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SUSAN ONAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 231-932-9030