MEDICARE: TRADING PLACES ADULT FAMILY HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639987845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRADING PLACES ADULT FAMILY HOME

Provider Business Mailing Address
First Line	:	10228 W BURLEIGH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-3304
Country	:	US
Telephone Number	:	414-208-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 N 21ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1504
Country	:	US
Telephone Number	:	414-208-3116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRAVION BURDINE
Credential	:
Telephone Number	:	414-208-3116

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	12/19/2024

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