Provider Demographics
NPI:1881928794
Name:TRANQUIL LIVING CENTER GROUP CORP
Entity type:Organization
Organization Name:TRANQUIL LIVING CENTER GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-300-5173
Mailing Address - Street 1:189 N HIGHWAY 89
Mailing Address - Street 2:STE C-10
Mailing Address - City:N SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 N HIGHWAY 89
Practice Address - Street 2:STE C-10
Practice Address - City:N SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2432
Practice Address - Country:US
Practice Address - Phone:801-300-5173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161210-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty