Provider Demographics
NPI:1326398371
Name:TRANQUILITY HOUSE LLC
Entity type:Organization
Organization Name:TRANQUILITY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN/NP
Authorized Official - Phone:602-369-1254
Mailing Address - Street 1:13428 W ACAPULCO LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6553
Mailing Address - Country:US
Mailing Address - Phone:602-369-1254
Mailing Address - Fax:623-337-5076
Practice Address - Street 1:13428 W ACAPULCO LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-6553
Practice Address - Country:US
Practice Address - Phone:602-369-1254
Practice Address - Fax:623-337-5076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANQUILITY HOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3984251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health