Provider Demographics
NPI:1831801109
Name:TRACEY'S HEALTH CARE SERVICE
Entity type:Organization
Organization Name:TRACEY'S HEALTH CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-671-2237
Mailing Address - Street 1:19046 BRUCE B DOWNS BLVD
Mailing Address - Street 2:STE B6 #967
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:317-671-2237
Mailing Address - Fax:
Practice Address - Street 1:15438 BROAD BRUSH DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573
Practice Address - Country:US
Practice Address - Phone:317-671-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health