1487657540 NPI number — TRANQUILITY HOME CARE, INC

Table of content: (NPI 1487657540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487657540 NPI number — TRANQUILITY HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANQUILITY HOME CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487657540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4231 GATE CRST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78217-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-967-0100
Provider Business Mailing Address Fax Number:
210-967-0118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4231 GATE CRST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78217-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-967-0100
Provider Business Practice Location Address Fax Number:
210-967-0118
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALBERTHAL
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
JEANETTE
Authorized Official Title or Position:
ADMINISTRATIVE ASSOCIATE
Authorized Official Telephone Number:
210-967-0100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  008068 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019210-0001 . This is a "SECURE HORIZONS PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7504380 . This is a "AETNA PPO PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 019210-0001 . This is a "PACIFICARE PROVIDER NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2964632 . This is a "AETNA HMO PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH309H . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".