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General NPI Number Information
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NPI Number | 1275277907
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Entity Type | Organization
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Legal Business Name | TRANQUILITY HOMES LLC
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 6695 MARLOWE AVE NE
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City | OTSEGO
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State | MN
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Zip | 55301-4556
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Country | US
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Telephone | 612-806-4318
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Fax |
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Provider Business Mailing Address
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Address Line | 6695 MARLOWE AVE NE
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City | OTSEGO
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State | MN
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Zip | 55301-4556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | JANE KUNGU
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Credential |
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Telephone | 612-806-4318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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