Provider Demographics
NPI:1235963729
Name:HANKINS, TRACY LAVONNE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LAVONNE
Last Name:HANKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 CONTINENTAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5006
Mailing Address - Country:US
Mailing Address - Phone:216-322-3204
Mailing Address - Fax:216-400-6939
Practice Address - Street 1:11122 CONTINENTAL AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-5006
Practice Address - Country:US
Practice Address - Phone:216-322-3204
Practice Address - Fax:216-400-6939
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251B00000XAgenciesCase Management
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No376J00000XNursing Service Related ProvidersHomemaker