Indian Trail Afc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AF280015720 Issued in MI

Legal business name

INDIAN TRAIL AFC

Practice address

844 Indian Trail Blvd
Traverse City, MI 49686-3640

Phone

(231) 631-4355

NPI assigned

Jul 13, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

George Warnick

Title

Owner

Phone

(231) 631-4355

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1154705804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 INDIAN TRAIL BLVD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863640",
            "telephone_number": "231-631-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "844 INDIAN TRAIL BLVD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863640",
            "telephone_number": "231-631-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TRAIL AFC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "WARNICK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-631-4355"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AF280015720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.