Provider Demographics
NPI:1174289631
Name:TRAILHEAD FAMILY AND LIFE SKILLS
Entity type:Organization
Organization Name:TRAILHEAD FAMILY AND LIFE SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-323-3349
Mailing Address - Street 1:512 N INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3142
Mailing Address - Country:US
Mailing Address - Phone:719-323-3349
Mailing Address - Fax:
Practice Address - Street 1:512 N INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3142
Practice Address - Country:US
Practice Address - Phone:719-323-3349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services