Provider Demographics
NPI:1962970046
Name:TRANQUIL HAVEN RESIDENTIAL CARE
Entity type:Organization
Organization Name:TRANQUIL HAVEN RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-400-3712
Mailing Address - Street 1:11880 SLATE FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8017
Mailing Address - Country:US
Mailing Address - Phone:916-294-5227
Mailing Address - Fax:
Practice Address - Street 1:37 MOSSGLEN CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-1722
Practice Address - Country:US
Practice Address - Phone:916-400-3712
Practice Address - Fax:916-382-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based