Provider Demographics
NPI:1205029980
Name:TRANQUILITY HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:TRANQUILITY HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:517-899-6369
Mailing Address - Street 1:1817 PEPPERTREE LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3724
Mailing Address - Country:US
Mailing Address - Phone:517-899-6369
Mailing Address - Fax:517-372-7161
Practice Address - Street 1:1817 PEPPERTREE LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3724
Practice Address - Country:US
Practice Address - Phone:517-899-6369
Practice Address - Fax:517-372-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID21187251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health