=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053582288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2008
-----------------------------------------------------
Last Update Date | 11/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8780 CRUSHEEN WAY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95828-6145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-405-6842
-----------------------------------------------------
Fax | 916-405-6843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8780 CRUSHEEN WAY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95828-6145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-405-6842
-----------------------------------------------------
Fax | 916-405-6843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MR. RICHARD EDWARD BEARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-429-7272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 347003531
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------