Healthcare Provider Details

I. General information

NPI: 1043183981
Provider Name (Legal Business Name): TRAILWAYS RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 REDBERRY ST APT A
LAS VEGAS NV
89108-4019
US

IV. Provider business mailing address

5317 REDBERRY ST APT A
LAS VEGAS NV
89108-4019
US

V. Phone/Fax

Practice location:
  • Phone: 702-371-7970
  • Fax:
Mailing address:
  • Phone: 702-371-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CRAIG HANCOCK II
Title or Position: OWNER
Credential:
Phone: 702-371-7970