Traverse Victorian Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

TRAVERSE VICTORIAN ASSISTED LIVING, LLC

Practice address

461 Munson Ave
Traverse City, MI 49686-3577

Phone

(231) 947-4626

NPI assigned

Aug 13, 2018

Last updated

Aug 13, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William Martin Eddington

Title

Representative

Phone

(231) 218-2948

Specialties & licenses 1

Addresses

Other names 1

• Traverse Victorian Assisted Living, LLC Other name

Locations

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1336628023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 MUNSON AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863577",
            "telephone_number": "231-947-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 MUNSON AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863577",
            "telephone_number": "231-947-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE VICTORIAN ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "EDDINGTON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "REPRESENTATIVE",
        "authorized_official_telephone_number": "231-218-2948",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Traverse Victorian Assisted Living, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Olivia Anne Travis, O.D.
• Corey K. Treadway, M.D.
• Krystal Marie Treadwell
• Breanna Tribelhorn, MD
• Kimberly Trierweiler

• Assisted Living Facility in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.