MEDICARE: TRANQUILITY SENIOR CARE INCORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1326532342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY SENIOR CARE INCORPORATION

Provider Business Mailing Address
First Line	:	17 FORT CAROLINE LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8443
Country	:	US
Telephone Number	:	386-338-8856
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 FORT CAROLINE LN
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8443
Country	:	US
Telephone Number	:	386-338-8856
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICKIE GRAYS
Credential	:
Telephone Number	:	386-338-8856

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	02/06/2019

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