Provider Demographics
NPI:1164262408
Name:TRANQUILITY MINNESOTA
Entity type:Organization
Organization Name:TRANQUILITY MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:SUMO
Authorized Official - Last Name:MIANTONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-404-9640
Mailing Address - Street 1:6385 OLD SHADY OAK RD STE 250
Mailing Address - Street 2:C/O BETTERHEALTH
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7705
Mailing Address - Country:US
Mailing Address - Phone:612-404-9640
Mailing Address - Fax:
Practice Address - Street 1:6385 OLD SHADY OAK RD STE 250
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7705
Practice Address - Country:US
Practice Address - Phone:612-404-9640
Practice Address - Fax:612-238-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)