Provider Demographics
NPI:1104681998
Name:HAZEL'S TRANQUILITY PLACE
Entity type:Organization
Organization Name:HAZEL'S TRANQUILITY PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-332-7825
Mailing Address - Street 1:4825 FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6856
Mailing Address - Country:US
Mailing Address - Phone:707-332-7825
Mailing Address - Fax:
Practice Address - Street 1:125 HUMPHREY LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7234
Practice Address - Country:US
Practice Address - Phone:707-332-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care