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General NPI Number Information
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NPI Number | 1003708991
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Entity Type | Organization
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Legal Business Name | TRANQUILA VIDA CARE OF INDIANA LLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 12002 LOGAN HUNTER TRL
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City | NOBLESVILLE
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State | IN
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Zip | 46060-9105
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Country | US
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Telephone | 463-301-4789
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Fax | 317-755-0445
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Provider Business Mailing Address
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Address Line | 12002 LOGAN HUNTER TRL
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City | NOBLESVILLE
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State | IN
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Zip | 46060-9105
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Country | US
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Telephone | 463-301-4789
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Fax | 317-755-0445
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Authorized Official
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Title or Position | SOLE MEMBER / RESPONSIBLE PARTY
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Name | DWAYNE ANTHONY HUTSON
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Credential |
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Telephone | 463-301-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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