Provider Demographics
NPI:1942502638
Name:TRANQUILITY PLACE OF UTAH LLC
Entity Type:Organization
Organization Name:TRANQUILITY PLACE OF UTAH LLC
Other - Org Name:TRANQUILITY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIA'ULI
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:801-924-9240
Mailing Address - Street 1:160 E 800 S STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3827
Mailing Address - Country:US
Mailing Address - Phone:801-924-9240
Mailing Address - Fax:801-924-9241
Practice Address - Street 1:160 E 800 S STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3827
Practice Address - Country:US
Practice Address - Phone:801-924-9240
Practice Address - Fax:801-924-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17016261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder