Healthcare Provider Details

I. General information

NPI: 1841020286
Provider Name (Legal Business Name): TRANQUIL HEART PRIMARY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 MONTANA AVE
EL PASO TX
79903-3712
US

IV. Provider business mailing address

2616 MONTANA AVE
EL PASO TX
79903-3712
US

V. Phone/Fax

Practice location:
  • Phone: 915-887-1801
  • Fax:
Mailing address:
  • Phone: 915-887-1801
  • 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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERRI MARIE MACIAS
Title or Position: OWNER
Credential:
Phone: 915-887-1801