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General NPI Number Information
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NPI Number | 1366546962
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Entity Type | Organization
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Legal Business Name | TRANQUILITY MANOR INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 902 HORNE AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3910
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Country | US
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Telephone | 757-558-0339
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Fax | 757-558-0377
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Provider Business Mailing Address
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Address Line | 902 HORNE AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3910
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Country | US
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Telephone | 757-558-0339
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Fax | 757-558-0377
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. PAUL JEROME BATTLE SR.
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Credential | BS/QMRP
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Telephone | 757-412-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 38601001
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License Number State | VA
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