# HAZEL'S TRANQUILITY PLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104681998
- **Authorized official:** KESHA PATRICE WILLIAMS (CEO)
- **Authorized official phone:** (707) 332-7825

## Contact information

- **Practice address:** 125 HUMPHREY LN, VALLEJO, CA 94591-7234
- **Practice address phone:** (707) 332-7825
- **Mailing address:** 4825 FERNWOOD CT, FAIRFIELD, CA 94534-6856
- **Mailing address phone:** (707) 332-7825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 172V00000X | Community Health Worker | — | NULL | — |
| 172V00000X | Community Health Worker | — | — | — |
| 177F00000X | Lodging Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 02/20/2024
- **Last updated:** 11/17/2024