Provider Demographics
NPI:1396813465
Name:TRANQUILITY INCORPORATED
Entity Type:Organization
Organization Name:TRANQUILITY INCORPORATED
Other - Org Name:SAN MIGUEL VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-825-4280
Mailing Address - Street 1:1050 SAN MIGUEL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2094
Mailing Address - Country:US
Mailing Address - Phone:925-825-4280
Mailing Address - Fax:925-676-1649
Practice Address - Street 1:1050 SAN MIGUEL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2094
Practice Address - Country:US
Practice Address - Phone:925-825-4280
Practice Address - Fax:925-676-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000186314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR55104HMedicaid
CA555104Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAZZR55104HMedicaid