Provider Demographics
NPI:1093592701
Name:TRAILWAYS PERSONAL CARE LLC
Entity Type:Organization
Organization Name:TRAILWAYS PERSONAL CARE LLC
Other - Org Name:TRAILWAYS PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:702-371-7970
Mailing Address - Street 1:4217 EL CONLON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0623
Mailing Address - Country:US
Mailing Address - Phone:702-371-7970
Mailing Address - Fax:702-371-7970
Practice Address - Street 1:3831 W CHARLESTON BLVD # 318
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1859
Practice Address - Country:US
Practice Address - Phone:702-371-7970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care