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General NPI Number Information
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NPI Number | 1104513316
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Entity Type | Organization
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Legal Business Name | TRANQUILITY HOME LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1845 E BROADWAY RD STE 113
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City | TEMPE
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State | AZ
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Zip | 85282-1634
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Country | US
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Telephone | 510-827-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N 2ND AVE APT 608
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City | PHOENIX
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State | AZ
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Zip | 85003
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Country | US
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Telephone | 510-827-5385
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS ROBERT BOB SSESANGA
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Credential |
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Telephone | 510-827-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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