| Tranquil Jc, Llc | |
|
2700 S Roan St Ste 212 Johnson City TN 37601-7557 | |
| (423) 430-9362 | |
| Not Available |
| Full Name | Tranquil Jc, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2700 S Roan St Ste 212, Johnson City, Tennessee |
| Authorized Official Name and Position | Rebecca Delong (OWNER) |
| Authorized Official Contact | 4234309362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tranquil Jc, Llc 3113 Indian Ridge Rd Johnson City TN 37604-2339 Ph: () - | Tranquil Jc, Llc 2700 S Roan St Ste 212 Johnson City TN 37601-7557 Ph: (423) 430-9362 |
| NPI Number | 1316552060 |
|---|---|
| Provider Enumeration Date | 09/10/2020 |
| Last Update Date | 09/10/2020 |
| Certification Date | 09/10/2020 |
| Medicare PECOS PAC ID | 9537587142 |
|---|---|
| Medicare Enrollment ID | O20200915000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316552060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rebecca Annette Delong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891099156 PECOS PAC ID: 6204019433 Enrollment ID: I20190501001997 |
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