Healthcare Provider Details

I. General information

NPI: 1528162542
Provider Name (Legal Business Name): TIFFANY CARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 STATE ST
MOUND CITY MO
64470-7202
US

IV. Provider business mailing address

1105 STATE ST PO BOX 308
MOUND CITY MO
64470-7202
US

V. Phone/Fax

Practice location:
  • Phone: 660-442-3128
  • Fax:
Mailing address:
  • Phone: 660-442-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN/A
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberN/A
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberN/A
License Number State
# 6
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberN/A
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberN/A
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberN/A
License Number State
# 10
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number StateMO
# 11
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberN/A
License Number State
# 12
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberN/A
License Number State
# 13
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberN/A
License Number State
# 14
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberN/A
License Number State

VIII. Authorized Official

Name: KIMBERLY R IRELAND
Title or Position: CEO
Credential:
Phone: 660-442-3128