Provider Demographics
NPI:1942697420
Name:TRANQUILITY HAVEN, LLC
Entity Type:Organization
Organization Name:TRANQUILITY HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-543-5911
Mailing Address - Street 1:1346 WILDERNESS LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-4219
Mailing Address - Country:US
Mailing Address - Phone:321-543-5911
Mailing Address - Fax:321-985-0335
Practice Address - Street 1:1346 WILDERNESS LN
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-4219
Practice Address - Country:US
Practice Address - Phone:321-543-5911
Practice Address - Fax:321-985-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11805310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility