Healthcare Provider Details

I. General information

NPI: 1821603564
Provider Name (Legal Business Name): A TRANQUIL CARE HOME AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 DAVID TAYLOR DR STE 120B
CHARLOTTE NC
28262-2362
US

IV. Provider business mailing address

5212 MERWYN AVE
CHARLOTTE NC
28215-3037
US

V. Phone/Fax

Practice location:
  • Phone: 980-202-9934
  • Fax: 704-800-3481
Mailing address:
  • Phone: 980-202-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH C AMOS
Title or Position: DIRECTOR
Credential:
Phone: 980-202-9923