Provider Demographics
NPI:1952108144
Name:DUNLAP, TRACY (CEO)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:
Credentials:CEO
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:R
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:5269 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8849
Mailing Address - Country:US
Mailing Address - Phone:317-657-9118
Mailing Address - Fax:
Practice Address - Street 1:5269 BIG BEND DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8849
Practice Address - Country:US
Practice Address - Phone:317-657-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health