=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336029693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY VALLEY ASSISTED LIVING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2025
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26450 HELENE DR
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-1876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-970-2018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26450 HELENE DR
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-1876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-970-2018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NICK VERMANI
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 909-548-1769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------