Healthcare Provider Details

I. General information

NPI: 1730162918
Provider Name (Legal Business Name): TRACY NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 2ND ST
TRACY MN
56175-1207
US

IV. Provider business mailing address

487 2ND ST
TRACY MN
56175-1207
US

V. Phone/Fax

Practice location:
  • Phone: 507-629-4850
  • Fax: 507-629-3774
Mailing address:
  • Phone: 507-629-4850
  • Fax: 507-629-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TENNES F EEG
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-629-4850