Provider Demographics
NPI:1831802388
Name:HOUSE OF TRANQUILITY GROUP HOME LLC
Entity type:Organization
Organization Name:HOUSE OF TRANQUILITY GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-577-9122
Mailing Address - Street 1:4706 N 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23612 W PECAN RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-7234
Practice Address - Country:US
Practice Address - Phone:602-577-9122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health