Healthcare Provider Details

I. General information

NPI: 1427938794
Provider Name (Legal Business Name): TRANQUIL RETREAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 COORS BLVD NW STE B
ALBUQUERQUE NM
87120-2712
US

IV. Provider business mailing address

9151 HIGH ASSETS WAY NW
ALBUQUERQUE NM
87120-5802
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-8867
  • Fax: 505-831-6254
Mailing address:
  • Phone: 505-379-8867
  • Fax: 505-831-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROL LYNN MICHELLE HERRERA
Title or Position: ADMINISTRATOR/OWNER
Credential: BA
Phone: 505-379-8867