Provider Demographics
NPI:1124897483
Name:KANE, TRACY LYNN
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WE ARE CARE
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WE ARE CARE LLC
Mailing Address - Street 1:2236 SOUTH HAMILTON ROAD
Mailing Address - Street 2:2236 SOUTH HAMILTON ROAD 201 A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4381
Mailing Address - Country:US
Mailing Address - Phone:614-965-5163
Mailing Address - Fax:
Practice Address - Street 1:2236 SOUTH HAMILTON ROAD
Practice Address - Street 2:2236 SOUTH HAMILTON ROAD 201 A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4381
Practice Address - Country:US
Practice Address - Phone:614-965-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver