| Tracys Residential Re Entry Center Inc | |
|
1365 Devonport Dr Lexington KY 40504-1552 | |
| (859) 309-2240 | |
| Not Available |
| Full Name | Tracys Residential Re Entry Center Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1365 Devonport Dr, Lexington, Kentucky |
| Authorized Official Name and Position | Chiquita Shields (PRESIDENT/DIRECTOR) |
| Authorized Official Contact | 8592298027 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracys Residential Re Entry Center Inc 1365 Devonport Dr Lexington KY 40504-1552 Ph: (859) 309-2240 | Tracys Residential Re Entry Center Inc 1365 Devonport Dr Lexington KY 40504-1552 Ph: (859) 309-2240 |
| NPI Number | 1932823929 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 10/03/2022 |
| Certification Date | 10/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932823929 | NPI | - | NPPES |
| 811063 | Other | KY | COMMONWEALTH OF KENTUCKY, CABINET FOR HEALTH AND FAMILY SERVICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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