Provider Demographics
NPI:1831501675
Name:TRAILS CAROLINA LLC
Entity Type:Organization
Organization Name:TRAILS CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNONHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-885-5920
Mailing Address - Street 1:500 WINDING GAP RD
Mailing Address - Street 2:
Mailing Address - City:LAKE TOXAWAY
Mailing Address - State:NC
Mailing Address - Zip Code:28747-8786
Mailing Address - Country:US
Mailing Address - Phone:828-885-5920
Mailing Address - Fax:828-885-5922
Practice Address - Street 1:500 WINDING GAP RD
Practice Address - Street 2:
Practice Address - City:LAKE TOXAWAY
Practice Address - State:NC
Practice Address - Zip Code:28747-8786
Practice Address - Country:US
Practice Address - Phone:828-885-5920
Practice Address - Fax:828-885-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27G.5200322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children