1962970046 NPI number — TRANQUIL HAVEN RESIDENTIAL CARE

Table of content: MISS JODI MICHELLE HIRSH MPT (NPI 1104049972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962970046 NPI number — TRANQUIL HAVEN RESIDENTIAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANQUIL HAVEN RESIDENTIAL CARE
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:
1962970046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11880 SLATE FALLS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95742-8017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-294-5227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 MOSSGLEN CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95826-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-400-3712
Provider Business Practice Location Address Fax Number:
916-382-4854
Provider Enumeration Date:
11/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
RAQUEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
916-400-3712

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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