Healthcare Provider Details

I. General information

NPI: 1629298328
Provider Name (Legal Business Name): TIFFANY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 HWY 39 SOUTH
LOUISBURG NC
27549
US

IV. Provider business mailing address

2294 GALLBERRY RD PO BOX 1785
WASHINGTON NC
27889-9178
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-6617
  • Fax: 525-946-2313
Mailing address:
  • Phone: 252-946-6617
  • Fax: 252-946-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberHAL035013
License Number StateNC

VIII. Authorized Official

Name: MISS TIFFANY COLLETTE EVERETT
Title or Position: PRESIDENT
Credential:
Phone: 252-946-6617