MEDICARE: TRANQUILITY SANDS HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1487266169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY SANDS HOSPICE, INC.

Provider Business Mailing Address
First Line	:	74333 HIGHWAY 111 STE 204
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4131
Country	:	US
Telephone Number	:	760-565-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	74333 HIGHWAY 111 STE 204
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4131
Country	:	US
Telephone Number	:	760-565-1774
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TRISTAN REPAREJO
Credential	:
Telephone Number	:	760-565-1774

Provider Enumeration Date	:	08/23/2020
Last Update Date	:	08/23/2020

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