Provider Demographics
NPI:1740418375
Name:TRACI'S PLACE, INC.
Entity Type:Organization
Organization Name:TRACI'S PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-295-8659
Mailing Address - Street 1:61816 BANNING LINE RD
Mailing Address - Street 2:
Mailing Address - City:ASKOV
Mailing Address - State:MN
Mailing Address - Zip Code:55704-4288
Mailing Address - Country:US
Mailing Address - Phone:651-295-8659
Mailing Address - Fax:
Practice Address - Street 1:61816 BANNING LINE RD
Practice Address - Street 2:
Practice Address - City:ASKOV
Practice Address - State:MN
Practice Address - Zip Code:55704-4288
Practice Address - Country:US
Practice Address - Phone:651-295-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1053045-1-WS311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home