Provider Demographics
NPI:1558198242
Name:TRANQUILITY RECOVERY NV LLC
Entity type:Organization
Organization Name:TRANQUILITY RECOVERY NV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUDAVERDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-900-8341
Mailing Address - Street 1:5840 W CRAIG RD # 120-253
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2561
Mailing Address - Country:US
Mailing Address - Phone:702-900-8341
Mailing Address - Fax:
Practice Address - Street 1:6325 HARRISON DR STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4402
Practice Address - Country:US
Practice Address - Phone:702-900-8341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANQUILITY RECOVERY NV LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty