Provider Demographics
NPI:1902603525
Name:TRANQUALITY HEAVEN LLC
Entity type:Organization
Organization Name:TRANQUALITY HEAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AGORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-781-5205
Mailing Address - Street 1:5131 AMBER VALLEY PKWY S APT 8
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8657
Mailing Address - Country:US
Mailing Address - Phone:701-781-5205
Mailing Address - Fax:
Practice Address - Street 1:5131 AMBER VALLEY PKWY S APT 8
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8657
Practice Address - Country:US
Practice Address - Phone:701-781-5205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care