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General NPI Number Information
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NPI Number | 1689161036
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Entity Type | Organization
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Legal Business Name | TRANQUIL COMMUNITY CARE SERVICES LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD STE 420C
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4839
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Country | US
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Telephone | 248-557-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 16000 W 9 MILE RD STE 420C
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4839
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Country | US
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Telephone | 248-557-0484
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KINSHASSA E BROWN
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Credential |
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Telephone | 419-360-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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