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General NPI Number Information
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NPI Number | 1427938794
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Entity Type | Organization
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Legal Business Name | TRANQUIL RETREAT LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 6400 COORS BLVD NW STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2712
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Country | US
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Telephone | 505-379-8867
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Fax | 505-831-6254
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Provider Business Mailing Address
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Address Line | 9151 HIGH ASSETS WAY NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-5802
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Country | US
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Telephone | 505-379-8867
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Fax | 505-831-6254
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | CAROL LYNN MICHELLE HERRERA
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Credential | BA
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Telephone | 505-379-8867
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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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