MEDICARE: PEACEFUL TRANQUILITY HOSPICE INCORPORATED

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	D10030	TX

General Provider Information

NPI Number	:	1609834407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL TRANQUILITY HOSPICE INCORPORATED

Provider Business Mailing Address
First Line	:	1610 BLODGETT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5017
Country	:	US
Telephone Number	:	713-523-5533
Fax Number	:	713-668-9590

Provider Business Practice Location Address
First Line	:	1610 BLODGETT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5017
Country	:	US
Telephone Number	:	713-523-5533
Fax Number	:	713-668-9590

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VANESSA EMAMI
Credential	:	BSN RN CWCN
Telephone Number	:	713-523-5533

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	11/06/2007

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