Provider Demographics
NPI:1720875701
Name:GEORGE, TRACEY LYNN (HOME CARE SERVICES)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:GEORGE
Suffix:
Gender:
Credentials:HOME CARE SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CHARLESTON WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3573
Mailing Address - Country:US
Mailing Address - Phone:317-666-1804
Mailing Address - Fax:
Practice Address - Street 1:1024 CHARLESTON WEST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3573
Practice Address - Country:US
Practice Address - Phone:317-666-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INQMA0100233251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health