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General NPI Number Information
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NPI Number | 1831801109
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Entity Type | Organization
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Legal Business Name | TRACEY'S HEALTH CARE SERVICE
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 15438 BROAD BRUSH DR
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City | SUN CITY CENTER
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State | FL
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Zip | 33573
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Country | US
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Telephone | 317-671-2237
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Fax |
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Provider Business Mailing Address
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Address Line | 19046 BRUCE B DOWNS BLVD STE B6 #967
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City | TAMPA
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State | FL
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Zip | 33647
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Country | US
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Telephone | 317-671-2237
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLARENCE THOMPKINS
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Credential |
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Telephone | 317-671-2237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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