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General NPI Number Information
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NPI Number | 1477492783
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Entity Type | Organization
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Legal Business Name | TRANQUIL HAVEN LLC
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 4118 ILLINOIS AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5950
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Country | US
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Telephone | 202-349-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 4118 ILLINOIS AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5950
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Country | US
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Telephone | 202-349-8471
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA JACKSON
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Credential |
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Telephone | 202-349-8471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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