Provider Demographics
NPI:1982843363
Name:TRANQUIL RETREAT, INC
Entity Type:Organization
Organization Name:TRANQUIL RETREAT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWANER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-682-8678
Mailing Address - Street 1:7224 W 29TH WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5342
Mailing Address - Country:US
Mailing Address - Phone:954-682-8678
Mailing Address - Fax:305-223-2371
Practice Address - Street 1:7224 W 29TH WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5342
Practice Address - Country:US
Practice Address - Phone:954-682-8678
Practice Address - Fax:305-223-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10319310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000375500Medicaid