Healthcare Provider Details

I. General information

NPI: 1417890336
Provider Name (Legal Business Name): CCRC OF TIFFIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VILLAGE DRIVE
TIFFIN IA
52340
US

IV. Provider business mailing address

6731 W 121ST ST STE 100
OVERLAND PARK KS
66209-2003
US

V. Phone/Fax

Practice location:
  • Phone: 913-890-4780
  • Fax:
Mailing address:
  • Phone: 913-890-4780
  • Fax: 913-956-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JORDAN R ANDERSON
Title or Position: MANAGER OF THE LLC
Credential:
Phone: 913-890-4780