Healthcare Provider Details

I. General information

NPI: 1104761089
Provider Name (Legal Business Name): TRANQUILITY HAVEN CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 44TH AVE SE
SALEM OR
97317-5407
US

IV. Provider business mailing address

276 44TH AVE SE
SALEM OR
97317-5407
US

V. Phone/Fax

Practice location:
  • Phone: 971-443-6051
  • Fax: 971-443-6056
Mailing address:
  • Phone: 971-443-6051
  • Fax: 971-443-6056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: FELECIA HOXABLE-SIMPSON
Title or Position: OWNER
Credential:
Phone: 971-406-5945