Provider Demographics
NPI:1447404843
Name:TRACIE ANN BRATCHER
Entity Type:Organization
Organization Name:TRACIE ANN BRATCHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN/CARE GIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:951-681-2259
Mailing Address - Street 1:8615 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5915
Mailing Address - Country:US
Mailing Address - Phone:951-681-2259
Mailing Address - Fax:951-681-2259
Practice Address - Street 1:8615 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5915
Practice Address - Country:US
Practice Address - Phone:951-681-2259
Practice Address - Fax:951-681-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home