Provider Demographics
NPI:1720494214
Name:EARLY TRAIL INC
Entity Type:Organization
Organization Name:EARLY TRAIL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRODAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-888-5486
Mailing Address - Street 1:322 EARLY TRAIL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-888-5486
Mailing Address - Fax:210-277-0487
Practice Address - Street 1:322 EARLY TRAIL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-888-5486
Practice Address - Fax:210-277-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility