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Organization

TRACY'S COUNTRY LIVING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CAROL B TRACY (OWNER)
(830) 665-5049
Entity
Organization

Contact information

Practice address
139 PR 6623 PO 96, DEVINE, TX 78016-0096
(830) 665-5049
(830) 665-5049
Mailing address
139PR 6623, DEVINE, TX 78016-0096
(830) 665-5049
(830) 665-5049

Taxonomy

Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000675800
PROVIDER ID
TX
Enumeration date
11/17/2006
Last updated
06/17/2008
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