Provider Demographics
NPI:1366546962
Name:TRANQUILITY MANOR INC
Entity type:Organization
Organization Name:TRANQUILITY MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:BS/QMRP
Authorized Official - Phone:757-412-8862
Mailing Address - Street 1:902 HORNE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3910
Mailing Address - Country:US
Mailing Address - Phone:757-558-0339
Mailing Address - Fax:757-558-0377
Practice Address - Street 1:902 HORNE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3910
Practice Address - Country:US
Practice Address - Phone:757-558-0339
Practice Address - Fax:757-558-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA38601001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities