Provider Demographics
NPI:1356841787
Name:TRANQUILITY HOSPICE,LLC
Entity Type:Organization
Organization Name:TRANQUILITY HOSPICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA TERESITA
Authorized Official - Middle Name:PATINO
Authorized Official - Last Name:ISIDERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-343-8045
Mailing Address - Street 1:8751 N 51ST AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4944
Mailing Address - Country:US
Mailing Address - Phone:480-343-8045
Mailing Address - Fax:623-939-3115
Practice Address - Street 1:8751 N 51ST AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4944
Practice Address - Country:US
Practice Address - Phone:480-343-8045
Practice Address - Fax:623-939-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC8134251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHSPC8134OtherSTATE LICENSE