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General NPI Number Information
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NPI Number | 1932823929
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Entity Type | Organization
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Legal Business Name | TRACYS RESIDENTIAL RE ENTRY CENTER INC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1365 DEVONPORT DR
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City | LEXINGTON
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State | KY
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Zip | 40504-1552
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Country | US
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Telephone | 859-309-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 DEVONPORT DR
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City | LEXINGTON
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State | KY
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Zip | 40504-1512
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Country | US
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Telephone | 859-309-2240
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Fax | 859-800-5261
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MISS CHIQUITA SHIELDS
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Credential |
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Telephone | 859-229-8027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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