MEDICARE: A TRANQUIL CARE HOME AGENCY, LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1821603564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A TRANQUIL CARE HOME AGENCY, LLC

Provider Business Mailing Address
First Line	:	5212 MERWYN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3037
Country	:	US
Telephone Number	:	980-202-9934
Fax Number	:

Provider Business Practice Location Address
First Line	:	9625 DAVID TAYLOR DR STE 120B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2362
Country	:	US
Telephone Number	:	980-202-9934
Fax Number	:	704-800-3481

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SARAH C AMOS
Credential	:
Telephone Number	:	980-202-9923

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	07/14/2021

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