Provider Demographics
NPI:1003533308
Name:VILLEDA'S TRANQUILITY HEALTH SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:VILLEDA'S TRANQUILITY HEALTH SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-747-9502
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 257S
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-747-9502
Mailing Address - Fax:
Practice Address - Street 1:8800 SE SUNNYSIDE RD STE 257S
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5738
Practice Address - Country:US
Practice Address - Phone:503-747-9502
Practice Address - Fax:877-744-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500757086Medicaid