Provider Demographics
NPI:1053684779
Name:TRANQUILITY HAVEN, LLC II
Entity Type:Organization
Organization Name:TRANQUILITY HAVEN, LLC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-543-5911
Mailing Address - Street 1:4030 VANCOUVER AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2725
Mailing Address - Country:US
Mailing Address - Phone:321-543-5911
Mailing Address - Fax:321-507-4698
Practice Address - Street 1:4030 VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-2725
Practice Address - Country:US
Practice Address - Phone:321-543-5911
Practice Address - Fax:321-507-4698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANQUILITY HAVEN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35197310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility