Provider Demographics
NPI:1639987845
Name:TRADING PLACES ADULT FAMILY HOME
Entity type:Organization
Organization Name:TRADING PLACES ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVION
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-208-3116
Mailing Address - Street 1:10228 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3304
Mailing Address - Country:US
Mailing Address - Phone:414-208-3116
Mailing Address - Fax:
Practice Address - Street 1:2529 N 21ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1504
Practice Address - Country:US
Practice Address - Phone:414-208-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health