Provider Demographics
NPI:1003708991
Name:TRANQUILA VIDA CARE OF INDIANA LLC
Entity type:Organization
Organization Name:TRANQUILA VIDA CARE OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / RESPONSIBLE PARTY
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:463-301-4789
Mailing Address - Street 1:12002 LOGAN HUNTER TRL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-9105
Mailing Address - Country:US
Mailing Address - Phone:463-301-4789
Mailing Address - Fax:317-755-0445
Practice Address - Street 1:12002 LOGAN HUNTER TRL
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-9105
Practice Address - Country:US
Practice Address - Phone:463-301-4789
Practice Address - Fax:317-755-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care