Provider Demographics
NPI:1194586438
Name:TRANQUIL MINDS
Entity type:Organization
Organization Name:TRANQUIL MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-532-3036
Mailing Address - Street 1:13754 STAR RUBY AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5558
Mailing Address - Country:US
Mailing Address - Phone:630-532-3036
Mailing Address - Fax:602-325-0555
Practice Address - Street 1:3326 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6459
Practice Address - Country:US
Practice Address - Phone:602-456-9804
Practice Address - Fax:602-325-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)