| Tranquility Recovery Nv Llc | |
|
6325 Harrison Dr Ste 2 Las Vegas NV 89120-4402 | |
| (702) 900-8341 | |
| (702) 549-7610 |
| Full Name | Tranquility Recovery Nv Llc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 6325 Harrison Dr Ste 2, Las Vegas, Nevada |
| Authorized Official Name and Position | Matthew Khudaverdyan (OWNER/CEO) |
| Authorized Official Contact | 7029008341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tranquility Recovery Nv Llc 3870 E Flamingo Rd # A2-525 Las Vegas NV 89121-6228 Ph: (702) 706-4969 | Tranquility Recovery Nv Llc 6325 Harrison Dr Ste 2 Las Vegas NV 89120-4402 Ph: (702) 900-8341 |
| NPI Number | 1568235893 |
|---|---|
| Provider Enumeration Date | 10/30/2023 |
| Last Update Date | 01/19/2024 |
| Certification Date | 01/19/2024 |
| Medicare PECOS PAC ID | 7810337276 |
|---|---|
| Medicare Enrollment ID | O20240502000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568235893 | NPI | - | NPPES |
| Provider Name | Gnaneswer Billakanti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922180595 PECOS PAC ID: 3577532803 Enrollment ID: I20041001000986 |
| Provider Name | Jayson Paulo A Agaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255761391 PECOS PAC ID: 1456582832 Enrollment ID: I20140327002110 |
| Provider Name | Nelandra Marion Anselmo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750522819 PECOS PAC ID: 2163864117 Enrollment ID: I20240522004001 |
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