Provider Demographics
NPI:1639790256
Name:TRAILWAYS LLC
Entity Type:Organization
Organization Name:TRAILWAYS LLC
Other - Org Name:TRAILWAYS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-301-5376
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-0454
Mailing Address - Country:US
Mailing Address - Phone:608-886-9023
Mailing Address - Fax:608-200-2417
Practice Address - Street 1:1001 ARBORETUM DR STE 110
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2670
Practice Address - Country:US
Practice Address - Phone:608-886-9023
Practice Address - Fax:608-200-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4370400Medicaid