Provider Demographics
NPI:1427938794
Name:TRANQUIL RETREAT LLC
Entity type:Organization
Organization Name:TRANQUIL RETREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL LYNN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:505-379-8867
Mailing Address - Street 1:9151 HIGH ASSETS WAY NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5802
Mailing Address - Country:US
Mailing Address - Phone:505-379-8867
Mailing Address - Fax:505-831-6254
Practice Address - Street 1:6400 COORS BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2712
Practice Address - Country:US
Practice Address - Phone:505-379-8867
Practice Address - Fax:505-831-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility