MEDICARE: TRANQUILITY RESOURCE MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	NV20181083391	NV

General Provider Information

NPI Number	:	1770082588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY RESOURCE MANAGEMENT

Provider Business Mailing Address
First Line	:	7324 MOUNTAIN THICKET ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4526
Country	:	US
Telephone Number	:	702-488-1425
Fax Number	:

Provider Business Practice Location Address
First Line	:	7324 MOUNTAIN THICKET ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4526
Country	:	US
Telephone Number	:	702-488-1425
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AUDREENA R HARRIS
Credential	:
Telephone Number	:	702-488-1425

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	02/07/2018

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